Wegener granülomatozisine bağlı subglottik darlıkta damak mukoza grefti ile cerrahi onarım

Elli altı yaşında kadın hastada akciğer tutulumu ile Wegener granülomatozisi var idi. Steroidler ile tedavi edilen hasta artan solunum sıkıntısı nedeni ile kliniğimize yönlendirildi. Radyolojik incelemede subglottik alanda 2 cm'lik bir darlık olduğu görüldü. Subglottik alanda kısmen dilate edilebilen yoğun granülasyon dokusu gösteren bronkoskopik bulgulara göre hastanın ameliyat edilmesine karar verildi. Krikoid düzey altındaki 15 mm'lik dar trakea segmenti rezeke edildi. Subglottik alana bir damak mukoza grefti uygulandı. Proksimal ucu distal trakeadan ses tellerine uzanacak şekilde bir Montgomery T tüp yerleştirildi. Trakeanın uçları anastomoz ile birleştirildi. Ameliyat sonrası komplikasyon yoktu. T tüp ameliyat sonrası altıncı ayda çıkarıldı ve hasta şu anda herhangi bir darlık olmaksızın takibin 12. ayındadır (T tüpün çıkarılmasını takiben). Steroid terapisine yanıt vermeyen subglottik darlığı olan Wegener granülomatozisi hastalarının tedavisi tartışmalıdır. Uygun hastalarda cerrahi tedavinin başarılı olabileceğini düşünüyoruz.

Surgical repair with palatal mucosal graft in subglottic stenosis caused by Wegener's granulomatosis

A 56-year-old female patient had Wegener's granulomatosis with lung involvement. Patient was being treated with steroids and was directed to our clinic for gradually increasing shortness of breath. The radiological examination showed a 2 cm stenosis in the subglottic area. We decided to operate on the patient according to the bronchoscopic findings which showed dense granulation tissue in the subglottic area which could only be dilated partially. The 15 mm narrow trachea segment under the cricoid level was resected. A palate mucosal graft was applied to the subglottic area. A Montgomery T-tube was inserted with its proximal end reaching the vocal cords from the distal trachea. The ends of trachea were joined through anastomosis. There were no postoperative complications. The T-tube was removed on the sixth postoperative month and the patient is currently in the 12th month of follow-up (after removal of T-tube) without any stenosis. The treatment of Wegener's granulomatosis patients with subglottic stenosis who do not respond to steroid therapy is controversial. We believe that surgical treatment can be successful in appropriate patients.

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1. Morales-Angulo C, García-Zornoza R, Obeso-Agüera S, CalvoAlén J, González-Gay MA. Ear, nose and throat manifestations of Wegener's granulomatosis (granulomatosis with polyangiitis). Acta Otorrinolaringol Esp 2012;63:206-11.
2. Bilgin M, Oğuzkaya F, Hasdıraz L, Özkaya M. Trakeal stenozlar: Cerrahi tedavi ve sonuçları. Turk Gogus Kalp Dama 2006;14:212-5.
3. Morcillo A, Wins R, Gómez-Caro A, Paradela M, Molins L, Tarrazona V. Single-staged laryngotracheal reconstruction for idiopathic tracheal stenosis. Ann Thorac Surg 2013;95:433-9.
4. Gouveris H, Karaiskaki N, Koutsimpelas D, Chongolwatana C, Mann W. Treatment for adult idiopathic and Wegenerassociated subglottic stenosis. Eur Arch Otorhinolaryngol 2013;270:989-93.
5. Montgomery WW. Posterior and complete laryngeal (glottic) stenosis. Arch Otolaryngol 1973;98:170-5.
6. Grillo HC, Mathisen DJ, Wain JC. Laryngotracheal resection and reconstruction for subglottic stenosis. Ann Thorac Surg 1992;53:54-63.