Surgical treatment of tracheal stenosis in children / 中华胸心血管外科杂志

Objective:To investigate the common types, surgical treatment and effects of tracheal stenosis in children.Methods:A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed, including 14 males and 9 females. The mean age at operation was(8.9±5.8)months(range: 2-3 months) and the mean weight was(6.4±2.3)kg(range: 4.2-10.5 kg). The common types of tracheal stenosis were complete tracheal ring in 9 children, tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4. The type of congenital heart diseases included 10 patients of pulmonary artery sling, 1 of tetralogy of Fallot, 5 of ventricular septal defect, 1 of pulmonary atresia, and 1 of right aortic arch with aberrant left subclavian artery. Slide tracheoplasty was performed in 9 patients, external splint in 8, endotracheal stent in 2 and tracheal dilation in 4. All children were followed up after 1, 3, 6, and 12 months of operation with CT and bronchoscopy.Results:There was 1 death in all 23 patients and the mortality was 4.3%, which died of granulation tissue hyperplasia after slide tracheoplasty. Reoperation was performed in 1 patient with endotracheal stent. All patients were followed for 1 to 24 months. Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion:Slide tracheoplasty is the effective surgical method for complete trachea ring. 3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.

Tracheal stent in surgery for tracheal stenosis caused by thyroid tumor / 中华内分泌外科杂志

Objective To discuss clinical application,value and effect of tracheal stent in surgical operation for tracheostenosis caused by thyroid tumor.Methods Clinical data of 6 patients with tracheal stenosis and dyspnea caused by thyroid tumor invasiveness or tracheal compression from Oct.2015 to Sep.2016 were retrospectively analyzed.Of the 6 patients,1 case had nodular goiter and 5 cases had differentiated thyroid carcinoma(DTC).Results All patients had dyspnea caused by thyroid tumor invasiveness or tracheal compression.Dyspnea relieved dramatically after tracheal stent was implantated under local anesthesia.Thyroidectomy was given later,with intraoperative tracheal intubation as well as anesthesia,and the surgery finally succeeded.One case with benign multinodular goiter received complete resection and 5 cases with DTC invading the trachea received complete resection of thyroid and neck lymph node dissection,followed by end-to-end anastomosis of invaded trachea sleeve resection.All patients got stage Ⅰ healing in surgical wound.Five cases received radioactive 131I treatment as well as TSH suppression therapy after DTC surgery.All patients were alive and disease-free after a follow-up of 4 to 15 months.Conclusions For patients with tracheostenosis caused by thyroid tumor invasiveness or tracheal compression,operation under cardiopulmonary bypass is necessary if tracheal intubation is difficult.For hospitals without cardiopulmonary bypass,tracheal stent implantation can effectively relieve dyspnea symptom and reduce risk of tracheal intubation under anesthesia,which provides possibility for surgical treatment.

Anesthetic management of a large mediastinal mass for tracheal stent placement / Manejo anestésico de grande massa mediastinal para a colocação de stent traqueal

ABSTRACT The anesthetic management of patients with large mediastinal masses can be complicated due to the pressure effects of the mass on the airway or major vessels. We present the successful anesthetic management of a 64-year-old female with a large mediastinal mass that encroached on the great vessels and compressed the trachea. A tracheal stent was placed to relieve the tracheal compression under general anesthesia. Spontaneous ventilation was maintained during the perioperative period with the use of a classic laryngeal mask airway. We discuss the utility of laryngeal mask airway for anesthetic management of tracheal stenting in patients with mediastinal masses.

RESUMO O manejo anestésico de pacientes com grandes massas situadas no mediastino pode ser complicado por causa dos efeitos da pressão da massa sobre as vias aéreas ou grandes vasos. Relatamos o manejo anestésico bem-sucedido de uma paciente de 64 anos com uma grande massa mediastinal que invadiu os grandes vasos e comprimiu a traqueia. Um stent traqueal foi colocado para aliviar a compressão da traqueia, sob anestesia geral. A ventilação espontânea foi mantida durante o período perioperatório com o uso de uma máscara laríngea clássica. Discutimos a utilidade da máscara laríngea para o manejo da colocação de stent traqueal em pacientes com massas situadas no mediastino.

Carcinoma broncogénico e insuficiencia respiratoria; electrofulguración del tumor, traqueobroncoplastia e implante de prótesis de urgencia / Bronchogenic carcinoma and respiratory insufficiency; tumor electrofulguration, tracheobronchoplasty and urgent stent placement

El cáncer de pulmón, de los más frecuentes y de muy alta mortalidad, en el departamento de Risaralda, Colombia presenta tasas por encima de 10 muertes por 100.000 habitantes.En fases iniciales la enfermedad no produce síntomas o son inespecíficos; cuando produce síntomas, usualmente está en una etapa avanzada. La disnea se presenta cuando la lesión tumoral compromete las vías respiratorias centrales y de acuerdo al grado de obstrucción, generalmente cuando es mayor a 50 porciento, que la hace grave. Se presenta el caso de un paciente que ingresa por cuadro clínico de insuficiencia respiratoria aguda secundaria a obstrucción traqueobronquial crítica por compromiso intraluminal de tumor broncogénico, de tipo escamocelular mal diferenciado; se realizó broncoscopia rígida, electrofulguración del tumor, citoreducción (“debulking”) mecánica, traqueo-broncoplastia e implante de prótesis traqueo-carino-brónquica (stent en Y) con resolución del cuadro agudo de manera inmediata posterior al procedimiento; posteriormente recibió quimioterapia con cisplatino / gemcitabine y radioterapia.

Lung cancer, one of the most frequent and with very high mortality, in the stateof Risaralda, Colombia, has rates above 10 deaths per 100.000 people.In early stages, disease doesn't produce symptoms or are nonspecific; whenproduce symptoms, usually is in advance stage.Dyspnea appears when tumor compromise central airway and depends onsevere obstruction, generally more than 50%, which makes it serious.Lung cancer presents a case of patient with acute respiratory insufficiency due tocritical trachea obstruction by bronchogenic tumor intraluminal commitmenttype, poorly differentiated squamous; at this stage it has been made rigidbronchoscopy, tumor with electrofulguration, mechanic debunking, tracheabronchoplasty and It takes immediate acute illness resolution; later he receivedcisplatin / gemcitabin chemotherapy and radiotherapy.

Reporte de caso: fístula traqueoesofágica e insuficiencia respiratoria tardía post stent metálico autoexpandible en esófago. Tratamiento con stent traqueal de Dumon / Case report: Tracheoesophageal Fistula and Respiratory Failure After the Placement of an Esophageal Metallic stent. Treatment Using a Dumon Stent

En los últimos años se ha presentado un gran avance tecnológico en el tratamiento endoscópico de pacientes con carcinoma inoperable, lo que permitió mejorar ostensiblemente la calidad de vida de muchos pacientes. Sin embargo, también se han observado nuevos síndromes clínicos relacionados con la utilización de estos recursos, por ejemplo, los stent esofágicos son una herramienta muy valiosa en el tratamiento paliativo de pacientes con carcinoma esofágico, pero infortunadamente no están exentos de complicaciones, sobre todo los nuevos dispositivos metálicos autoexpandibles. Las fuerzas radiales generadas por estos, frecuentemente producen compresión extrínseca traqueal e insuficiencia respiratoria. Presentamos un caso de insuficiencia respiratoria y hemoptisis secundarias a la colocación de un stent esofágico autoexpandible y el tratamiento de esta complicación con un stent de Dumon.

We have seen major technological advances in the endoscopic treatment of patients with inoperable cancer in the past years. This situation has allowed improve the quality of life of many patients, but we have also seen new clinical syndromes associated with the use of these resources. For example, esophagic stents are invaluable tools in the palliative treatment of patients with esophageal cancer, but unfortunately these are not free of complications, especially the new self-expandable metallic stents. Metallic stents produce enormous radial forces and these devices may develop extrinsic tracheal compression with progressive respiratory failure. We present a case of respiratory distress and hemoptysis secondary to the placement of a self-expanding esophageal stent and treatment of this complication with Dumon stent.

The use of the Montgomery T-tube in postprocedural subglottic stenosis repair / 대한마취과학회지

The Montgomery T-tube is a device that supports the trachea and facilitates ventilation after laryngotracheal surgery. Because its use is sporadic, many anesthesiologists may not be familiar with this device, and its anesthetic management requires careful planning and discussion with surgeons. We describe the techniques of anesthetic management of exchanging endotracheal tube to Montgomery T-tube in case where upper tracheal stenosis exists.

Laryngeal Mask Airway in Patient with T-Tube Tracheal Stent who are Undergoing Non-Airway Related Surgery -A case report- / 대한마취과학회지

Some patient with T-tube tracheal stent may need to be anesthetized to be performed the non-airway related surgery. Without removal of the stent, general anesthesia with endotracheal intubation in these patents may cause serious complications, such as stent dislodgement, bleeding and breakage of stent. We describe a 43-year-old woman with a T-tube stent in situ, who was anesthetized using Laryngeal Mask Airway (LMA) for her ventriculo-peritoneal shunt operation. We occluded the top end of the LMA, thus employed it as a means of upper airway occlusion, while ventilation continued via the extratracheal portion of the T-tube stent, without any complications.

Metallic intratracheai stent application on relapsing polychondritis with severe tracheobronchial malacia / 介入放射学杂志

Objective To evaluate the therapeutic and adverse effects of metallic intratracheal stent placement in relapsing polychondritis with severe tracheobronchial malacia.Methods Five tracheal stents had been implanted in three patients with traeheobronchial malacia.One patient was implanted with two tubular steuts in trachea and one“Y”shaped stent for bilateral bronchi.Another patient used a tubular stent in total tracheal segment.The last patient used a tubular stent in the upper segment of trachea.Results All the stents were implanted successfully with obvious improvement of dyspnea after the treatment. Conclusions Metallic intratracheal stent placement can really relieve symptoms and improve the life quality in patients with tracheobronchial malacia caused by relapsing polychondritis.