[The role of tracheal stenting in the alternative treatment of tracheal stenosis]

ABSTRACT

Tracheal stenosis due to trauma, tracheal infections, and malignant tracheal tumors and after long standing intubation is seen. Most researchers think that resection and anastomosis of trachea is the best treatment of tracheal stenosis in most times, and the best results are obtained when performed by a skilled surgeon. But the important complication of tracheal surgery is post-operative tracheal stenosis which leads to some limits in reoperations. The role of stenting in treatment of tracheal stenosis is as alternative treatment in patients who are not compatible with major operations and the first treatment in patients with tracheal malignancies along with involvement of near elements or distant metastasis that are not operable. The goal of this research is the study of results of stenting in Tehran Valiasr hospital between October 2002 till September 2004. This is a prospective research that is about the results of tracheal stenting in patients with inoperable tracheal malignancy, non tumoral stenosis [after long standing intubation], complication of surgery or inability to stand a major operation. Stent insertion was done by rigid bronchoscopy and use of silicon stent [polyflex with introducer system]. 12 patients with stents [10 due to benign lesion and 2 due to malignancy] have been worked up for at least 6 months and at most one year. Average age of patients was 30 [least 13 and most 53]. 9 patients were affected to stenosis after longstanding intubation due to various causes of [45.4%] and one case, stenosis due to inhalation of chemical gas [8.4%] and two cases [16.6%] due to thyroid tumor invited to trachea and adenocystic tumor of trachea. Stenosis was between 2-5[cm]. Four cases of stenosis were in superior and middle third and four cases in inferior third. The most important indication of stent insertion is the history of multiple tracheal operations. The most common complications of stent insertion is development of granulation tissue [58%] and medium time of lasting stent in place has been 2-6 months. The most common cause of stent removal is also granulation tissue formation [85%].30% of patients with benign disease have been cured with stent insertion and 10% were improved until they could stand a major operation. In malignant condition one patient recovered from death and lived for 3 months and the other patient gained enough time to do radiotherapy. The results of this research revealed that mostly in benign conditions after stent removal, patients showed signs of recurrence which needed another alternative treatment. This problem makes the role of stent insertion questionable in benign conditions. But the use of stent in malignant conditions is indicated when is the only alternative. Treatment and its role are approved and another benefit is that in malignancies the stent removal is not need