1
|
Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, Starostin AV. [Tracheolaryngeal resection for cicatricle stenosis]. Khirurgiia (Mosk) 2018:41-48. [PMID: 29953099 DOI: 10.17116/hirurgia2018641-48] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
AIM To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches. MATERIAL AND METHODS For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy. RESULTS In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - M A Rusakov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Starostin
- Sechenov First Moscow State Medical University of Healthcare Ministry of Russia, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| |
Collapse
|
2
|
Parshin VD, Titov VA, Parshin VV, Parshin AV, Berikkhanov Z, Amangeldiev DM. [Circular tracheal resection for cicatrical stenosis and functioning tracheostomy]. Khirurgiia (Mosk) 2017:23-32. [PMID: 28914829 DOI: 10.17116/hirurgia2017923-32] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
AIM To analyze the results of tracheal resection for cicatricial stenosis depending on the presence of tracheostomy. MATERIAL AND METHODS 1128 patients with tracheal cicatricial stenosis were treated for the period 1963-2015. The first group consisted of 297 patients for the period 1963-2000, the second group - 831 patients for the period 2001-2015. Most of them 684 (60.6%) were young and able-bodied (age from 21 to 50 years). In the first group 139 (46.8%) out of 297 patients had functioning tracheostomy. For the period 2001-2015 tracheostomy was made in 430 (51.7%) out of 831 patients with cicatricial stenosis. Time of cannulation varied from a few weeks to 21 years. RESULTS Re-tracheostomy within various terms after decanulation was performed in 68 (15.8%) patients. Tracheal resection with anastomosis was performed in 59 and 330 in both groups respectively. At present time these operations are performed more often in view of their standard fashion in everyday practice. In the second group tracheal resection followed by anastomosis was observed in 110 (25.6%) out of 430 patients with tracheostomy that is 4.4 times more often than in previous years. In total 2 patients died after 330 circular tracheal resections within 2001-2015 including one patient with and one patient without tracheostomy. Mortality was 0.6%. Moreover, this value was slightly higher in patients operated with a functioning tracheostomy compared with those without it - 0.9 vs. 0.5% respectively. The causes of death were bleeding into tracheobronchial lumen and pulmonary embolism. The source of bleeding after tracheal resection was innominate artery. Overall incidence of postoperative complications was 2 times higher in tracheostomy patients compared with those without it - 22 (20%) vs. 26 (11.8%) cases respectively. Convalescence may be achieved in 89.8% patients after circular tracheal resection. Adverse long-term results are associated with postoperative complications. So their prevention and treatment will improve the outcomes.
Collapse
Affiliation(s)
- V D Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V A Titov
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - V V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - A V Parshin
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - Z Berikkhanov
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| | - D M Amangeldiev
- Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia
| |
Collapse
|
3
|
Kulbakin D, Chekalkin T, Muhamedov M, Choynzonov E, Kang JH, Kang SB, Gunther V. Sparing Surgery for the Successful Treatment of Thyroid Papillary Carcinoma Invading the Trachea: A Case Report. Case Rep Oncol 2016; 9:772-780. [PMID: 27990114 PMCID: PMC5156893 DOI: 10.1159/000452790] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/24/2016] [Accepted: 10/24/2016] [Indexed: 11/21/2022] Open
Abstract
Published reports on salvage treatment for trachea reconstruction after total thyroidectomy or partial tracheotomy are available, some of them using structures of the trachea itself, auricular cartilage, a musculocutaneous flap, or other methods. In our report, we emphasize the importance of a search for a new material and approach for sparing surgery. The purpose of this article is to describe a case of a successful sparing surgery in a patient with advanced thyroid papillary carcinoma invading the trachea. After total thyroidectomy in 2012, partial resection of the trachea was performed in 2014. The lesion defect was 5.5 × 2.3 cm in size, located between 4 (2nd–6th) tracheal cartilaginous rings and involving about a semicircumference. It was reconstructed with the aid of the knitted TiNi-based mesh endograft, which has been prefabricated in the sternocleidomastoid muscle and further covered with the skin draped over the wound. The tracheostoma was fully closed 6 weeks after the surgery. There were neither side effects nor complications. This kind of tracheal surgery for extensive lesions demonstrates good functional and cosmetic outcomes.
Collapse
Affiliation(s)
- Denis Kulbakin
- Tomsk State University, Tomsk, Russian Federation; Tomsk Cancer Research Institute, Tomsk, Russian Federation
| | - Timofey Chekalkin
- Tomsk State University, Tomsk, Russian Federation; Kang & Park Medical Co. Ltd., Cheongju, South Korea
| | | | | | - Ji-Hoon Kang
- Kang & Park Medical Co. Ltd., Cheongju, South Korea
| | | | | |
Collapse
|
4
|
Hohenforst-Schmidt W, Linsmeier B, Zarogoulidis P, Freitag L, Darwiche K, Browning R, Turner JF, Huang H, Li Q, Vogl T, Zarogoulidis K, Brachmann J, Rittger H. Transtracheal single-point stent fixation in posttracheotomy tracheomalacia under cone-beam computer tomography guidance by transmural suturing with the Berci needle - a perspective on a new tool to avoid stent migration of Dumon stents. Ther Clin Risk Manag 2015; 11:837-50. [PMID: 26045666 PMCID: PMC4448926 DOI: 10.2147/tcrm.s83230] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
Tracheomalacia or tracheobronchomalacia (TM or TBM) is a common problem especially for elderly patients often unfit for surgical techniques. Several surgical or minimally invasive techniques have already been described. Stenting is one option but in general long-time stenting is accompanied by a high complication rate. Stent removal is more difficult in case of self-expandable nitinol stents or metallic stents in general in comparison to silicone stents. The main disadvantage of silicone stents in comparison to uncovered metallic stents is migration and plugging. We compared the operation time and in particular the duration of a sufficient Dumon stent fixation with different techniques in a patient with severe posttracheotomy TM and strongly reduced mobility of the vocal cords due to Parkinson’s disease. The combined approach with simultaneous Dumon stenting and endoluminal transtracheal externalized suture under cone-beam computer tomography guidance with the Berci needle was by far the fastest approach compared to a (not performed) surgical intervention, or even purely endoluminal suturing through the rigid bronchoscope. The duration of the endoluminal transtracheal externalized suture was between 5 minutes and 9 minutes with the Berci needle; the pure endoluminal approach needed 51 minutes. The alternative of tracheobronchoplasty was refused by the patient. In general, 180 minutes for this surgical approach is calculated. The costs of the different approaches are supposed to vary widely due to the fact that in Germany 1 minute in an operation room costs on average approximately 50–60€ inclusive of taxes. In our own hospital (tertiary level), it is nearly 30€ per minute in an operation room for a surgical approach. Calculating an additional 15 minutes for patient preparation and transfer to wake-up room, therefore a total duration inside the investigation room of 30 minutes, the cost per flexible bronchoscopy is per minute on average less than 6€. Although the Dumon stenting requires a set-up with more expensive anesthesiology accompaniment, which takes longer than a flexible investigation estimated at 1 hour in an operation room, still without calculation of the costs of the materials and specialized staff that the surgical approach would consume at least 3,000€ more than a minimally invasive approach performed with the Berci needle. This difference is due to the longer time of the surgical intervention which is calculated at approximately 180 minutes in comparison to the achieved non-surgical approach of 60 minutes in the operation suite.
Collapse
Affiliation(s)
- Wolfgang Hohenforst-Schmidt
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany ; II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Bernd Linsmeier
- Department of Thoracic Surgery, Medinos Clinic Sonneberg, Sonnerberg, Germany
| | - Paul Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Lutz Freitag
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Kaid Darwiche
- Department of Interventional Pneumology, Ruhrlandklinik, University Hospital Essen, University of Essen-Duisburg, Tueschener Weg, Essen, Germany
| | - Robert Browning
- Pulmonary and Critical Care Medicine, Interventional Pulmonology, National Naval Medical Center, Walter Reed Army Medical Center, Bethesda, MD, USA
| | - J Francis Turner
- Division of Interventional Pulmonology and Medical Oncology, Cancer Treatment Centers of America, Western Regional Medical Center, Goodyear, AZ, USA
| | - Haidong Huang
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Qiang Li
- Department of Respiratory Diseases Shanghai Hospital, II Military University Hospital, Shanghai, People's Republic of China
| | - Thomas Vogl
- Department of Diagnostic and Interventional Radiology, Goethe University of Frankfurt, Frankfurt, Germany
| | - Konstantinos Zarogoulidis
- Pulmonary Department-Oncology Unit, "G. Papanikolaou" General Hospital, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Johannes Brachmann
- II Medical Clinic, "Coburg" Hospital, University of Wuerzburg, Coburg, Germany
| | - Harald Rittger
- Medical Clinic I, "Fuerth" Hospital, University of Erlangen, Fuerth, Germany
| |
Collapse
|
5
|
Muhamedov M, Kulbakin D, Gunther V, Choynzonov E, Chekalkin T, Hodorenko V. Sparing surgery with the use of tini-based endografts in larynx cancer patients. J Surg Oncol 2014; 111:231-6. [PMID: 25176032 DOI: 10.1002/jso.23779] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Accepted: 08/07/2014] [Indexed: 11/08/2022]
Affiliation(s)
- Marat Muhamedov
- Tomsk Cancer Research Institute; Russian Academy of Medical Science; Tomsk Russia
| | - Denis Kulbakin
- Tomsk Cancer Research Institute; Russian Academy of Medical Science; Tomsk Russia
| | - Victor Gunther
- Research Institute of Medical Materials; Tomsk State University; Tomsk Russia
| | - Evgeniy Choynzonov
- Tomsk Cancer Research Institute; Russian Academy of Medical Science; Tomsk Russia
| | - Timofey Chekalkin
- Research Institute of Medical Materials; Tomsk State University; Tomsk Russia
| | - Valentina Hodorenko
- Research Institute of Medical Materials; Tomsk State University; Tomsk Russia
| |
Collapse
|
6
|
Bacon JL, Patterson CM, Madden BP. Indications and interventional options for non-resectable tracheal stenosis. J Thorac Dis 2014; 6:258-70. [PMID: 24624290 DOI: 10.3978/j.issn.2072-1439.2013.11.08] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/30/2013] [Accepted: 11/20/2013] [Indexed: 12/12/2022]
Abstract
Non-specific presentation and normal examination findings in early disease often result in tracheal obstruction being overlooked as a diagnosis until patients present acutely. Once diagnosed, surgical options should be considered, but often patient co-morbidity necessitates other interventional options. Non-resectable tracheal stenosis can be successfully managed by interventional bronchoscopy, with therapeutic options including airway dilatation, local tissue destruction and airway stenting. There are common aspects to the management of tracheal obstruction, tracheomalacia and tracheal fistulae. This paper reviews the pathogenesis, presentation, investigation and management of tracheal disease, with a focus on tracheal obstruction and the role of endotracheal intervention in management.
Collapse
|
7
|
Jiang AG, Gao XY, Lu HY. Diagnosis and management of an elderly patient with severe tracheomalacia: A case report and review of the literature. Exp Ther Med 2013; 6:765-768. [PMID: 24137262 PMCID: PMC3786812 DOI: 10.3892/etm.2013.1195] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Accepted: 06/27/2013] [Indexed: 11/06/2022] Open
Abstract
Severe adult tracheomalacia is a dangerous disease that is difficult to manage, particularly at the time of airway infection, and has a high mortality rate. The present study reports the diagnosis and treatment of an elderly patient with severe adult tracheomalacia. In March 2012, the 59-year-old patient presented with progressive dyspnea to the Department of Respiratory Medicine, Taizhou People's Hospital (Jiangsu, China). Following admission, chest radiography revealed symptoms consistent with chronic obstructive pulmonary disease (COPD) and chest computed tomography (CT) demonstrated an evident stenosis of the tracheal lumen at the end of expiration. Bronchoscopy revealed a 91% reduction in the cross-sectional area of the tracheal lumen at the end of expiration. Following the final diagnosis, the patient was successfully treated with nasal continuous positive airway pressure (CPAP) combined with implantation of a temporary Chinese Li's metallic stent. These treatment methods appeared to be temporarily effective in alleviating the symptoms of the disease.
Collapse
Affiliation(s)
- Ai-Gui Jiang
- Department of Respiratory Medicine, Taizhou People's Hospital, Taizhou, Jiangsu 225300, P.R. China
| | | | | |
Collapse
|
8
|
Knox GW. In reference toLate complications of nickel-titanium alloy stent in tracheal stenosis. Laryngoscope 2013; 123:549. [DOI: 10.1002/lary.23587] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2012] [Accepted: 06/11/2012] [Indexed: 11/08/2022]
|