Clinical Analysis of Cases of Segmental Resection and Primary Anastomosis in Tracheal Stenosis

기관 절제 및 단단 문합술에 의한 기관 협착증의 치료

Despite improvement in respiratory care, including use of low pressure and high volume cuffed tubes, tracheal stenosis remains a serious complication after a long-term tracheal intubation and tracheostomy. In such patients, tracheal resection and primary anastomosis is still considered ideal therapeutic modality. Between 1989 and 1997, we performed tracheal resections with end-to-end anastomosis on 14 patients with no operative mortality and some morbidity. Tracheal stenosis was caused by tracheostomy in nine patients, by endotracheal intubation in three patients and by thyroid carcinoma in two patients. The length of stenosis was various from 2cm to 4.5cm. All patient underwent segmental tracheal resection and primary anastomosis(14 patients) and additional procedures were cricoid cartilage reconstruction(2 patients), suprahyoid laryngeal release(3patients), carinal release technique(2 patients) and arytenoidectomy(2 patients). We have nine complications: granulona at anastomosis site in four patients, vocal cord palsy in two patients and restenosis, pneumonia, skin necrosis in each of those patients. The granuloma was removed by bronchoscopic forceps(4 patients). Vocal cord palsy was treated by arytenoidectorny(2 patients), restenosis by T-tube insertion, pneumonia by antibiotics and skin necrosis was treated by skin graft. We reviews our expenence of clinical features of tracheal stenosis and surgical treatment by tracheal one-to-end anastomosis with additional procedures to avoid postoperative complications for sucessful results.