Elif TANRIVERDİ, Mehmet Akif ÖZGÜL, Güler ÖZGÜL, Şule GÜL, Demet TURAN, Erdoğan ÇETİNKAYA, Gamze KIRKIL, Efsun Gonca UĞUR CHOUSEIN

Postentübasyon/posttrakeostomi trakeal stenozlarda 8 yıllık tecrübemiz

Giriş: Travmaya bağlı trakeal stenozun en sık nedeni postentübasyon/postrtakeostomi trakeal stenozlardır. Trakeobronşiyal patolojilerin tespitinde ve tedavisinde bronkoskopi altın standarttır. Trakeal stenoz tedavisinde pek çok seçenek olup, trakeal stenozlu hastalarımızın tedavi opsiyonlarını ve takiplerini tartışmak istedik. Materyal ve Metod: 2009-2018 yılları arasında trakeal stenoz nedeniyle bize refere edilmiş hastalarımız çalışma için değerlendirildi. Hastaların tüm demografik verileri, stenozun lokalizasyonu, uzunluğu, derecesi, tedavi teknikleri, postoperatif komplikasyonlar ve sürvileri kaydedilmişti. Bulgular: Toplam 110 hasta çalışmaya alındı. Ortalama yaş 53.7 ± 16.7 (16-98 yıl) idi. Yüz on hastanın 54 (%49.1)’ü kadındı. En sık rastlanan darlık tipi, kompleks tipte trakeal stenozdu (%74.5). Hastaların hepsine mekanik dilatasyon uygulanmıştı. Yirmi iki (%20) hastanın darlık alanı makasla kesilmişti. Kırk dokuz (%44.5) hastaya trakeal stent yerleştirilmişti. Takiplerde 110 hastanın 36 (%32.7)’sına göğüs cerrahisince trakeal rezeksiyon uygulandı. Cerrahi geçiren 36 hastanın 6 (%16.7)’sı takiplerde yaşamını kaybetti (1 hasta cerrahi sırasında kaybedildi). On yedi (%47.2) hasta cerrahi sonrası tamamen iyileşti. On üç (%36.1) hastada cerrahi sonrası restenoz gelişti. Sonuç: Trakeal stenoz sıklıkla entübasyon ya da trakeostomi sonrası ortaya çıkan bir durumdur ve çeşitli tedavide modaliteleri vardır. Kontrendike olmadığı durumlarda, cerrahi tedavi, uygun olgularda daha etkili kabul edilmektedir. Cerrahinin kontrendike olduğu durumlarda endoskopik girişimler cerrahiye alternatif olarak önerilebilir. Girişimsel işlemler sonrası hastalar komplikasyon ve restenoz gelişebileceğinden takip edilmelidir.

Our eight years experience in postintubation/ posttracheostomy tracheal stenosis

Introduction: The most common cause of tracheal stenosis (TS) continues tobe traumas according to the intubation and tracheostomy. Bronchoscopy isconsidered the gold standard for the detection and diagnosis of tracheobronchial pathology. There are several treatment options. We aimed to discuss ourtracheal stenosis patients’ treatment options, and their follow-up period.Materials and Methods: Consecutive referred patients between 2009 and2018 presenting with TS were reviewed for the study. Demographic characteristics, localization, length and degree of stenosis, treatment techniques,postoperative complications, and survival were recorded for all patients.Results: A total of 110 patients included. The mean age was 53.7 ± 16.7 (16-98 years) years. Of 110 patients, 54 (49.1%) were female. Most commontype of stenosis was complex stenosis (74.5%). Mechanical dilatation wasapplied to all patients. Stenotic regions of 22 (20%) patients were cut withbronchoscopic scissor. Tracheal stents were inserted into trachea of 49(44.5%) patients. During follow-up period; 36 of 110 (32.7%) patients hadsurgical resection. Six of 36 (16.7%) patients died during follow-up period(one of them died during surgery), 17 (47.2%) patients had total recoveryafter surgery. Thirteen of 36 (36.1%) patients had restenosis after surgeryConclusion: Tracheal stenosis is a process seen after postintubation or posttracheostomy frequently and it has a wide range of management modalities. Although, it is believed that surgery is the most efficient technique in cases without medical contraindications,we determined that endoscopic interventions can be alternative therapeutic options for inoperable patients. Patients must be followed-up after interventional therapies because complications, and restenosis can usually be seen.

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