The Short Term and Intermediate Term Results of using a T-tube in Patients with Tracheal Stenosis

기관 협착 환자에서의 T-튜브의 중단기 결과

  • Sa, Young Jo (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Moon, Seok-Whan (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Kim, Young-Du (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Jin, Ung (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Park, Jae-Kil (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Kim, Jae Jun (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Kim, Chi-Kyung (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Jo, Keon Hyon (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Park, Chan Beom (Department of Thoracic and Cardiovascular Surgery, The Catholic University of Korea College of Medicine) ;
  • Yim, Hyeon Woo (Department of Preventive Medicine, The Catholic University of Korea College of Medicine)
  • 사영조 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 문석환 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 김영두 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 진웅 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 박재길 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 김재준 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 김치경 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 조건현 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 박찬범 (가톨릭대학교 의과대학 흉부외과학교실) ;
  • 임현우 (가톨릭대학교 의과대학 예방의학교실)
  • Received : 2008.08.05
  • Accepted : 2008.10.10
  • Published : 2009.02.05

Abstract

Background: The treatment of tracheal stenosis includes less invasive bronchoscopic intervention and more invasive segmental resection & anastomosis. Depending on the patient's clinical features, sometimes all these methods are inappropriate. Silicone T-tube stenting has recently been used as an alternative, safe management of tracheal stenosis. We studied the short term and Intermediate term results of using T-tubes in patients with tracheal stenosis, and this tracheal stenosis was caused by various underlying diseases. Material and Method: We retrospectively reviewed 57 patients with tracheal stenosis and who were treated with T-tubes between Jan 1997 and Apr 2007. Based on the patient's medical records and the imaging studies, we evaluated the clinical findings and status of T-tube removal. Result: There was no T-tube related morbidity or mortality in this series. On follow-up, one patient underwent sleeve resection and end-to-end anastomosis. The T-tube could be successfully removed from 13 patients (13/57, 22.8%) without additional interventions. For another four patients, a T-tube was again inserted after removal of the first T-tube due to tracheomalacia or recurrent stenosis. Four patients died of underlying disease and cancer. The patients' gender and previous tracheostomy significantly affected T-tube removal. By contrast, multiple logistic regression analysis identified gender as a predictor of successfully removing a T-tube. Gender (p=0.033) and previous tracheostomy (p=0.036) were the two factors for success or failure of T-tube removal. Conclusion: A T-tube provided reliable patency of a stenotic airway that was caused by any etiology. We have proven that using a T-tube is safe and effective therapy for patients with tracheal stenosis for the short term or the intermediate term.

배경: 기관 협착의 치료방법은 비교적 덜 침습적인 기관지내시경을 이용한 시술 또는 침습적인 방법인 구역절제술과 문합의 방법이 있으나 가끔은 환자의 임상적 특징에 따라 이 모든 방법이 불가능할 때도 있다. 최근 실리콘 T-튜브 스텐트가 안전한 치료 대안이 되고 있다. 우리는 다양한 기저질환을 가진 기관 협착 환자에서 T-튜브의 중단기 결과를 조사하였다. 대상 및 방법: 1997년 1월부터 2007년 4월까지 10년 동안 T-튜브로 기관협착을 치료받은 환자 57명을 후향적으로 검토하였다. 환자의 의무기록과 영상검사를 기초로 하여, 임상적인 결과와 T-튜브 제거유무를 조사하였다. 결과: T-튜브와 연관된 합병증과 사망은 없었다. 경과 관찰 기간 동안 1명의 환자는 협착부위 절제와 재건술을 받았다. 13명의 환자들(13/57, 22.8%)은 성공적으로 T-튜브를 제거하여 더 이상 다른 처치는 필요하지 않았다. 또 다른 4명의 환자는 기관연화와 기관협착의 재발로 T-튜브 제거 후 다시 삽입하였다. 4명의 환자들은 기저질환과 암으로 사망하였다. 성별과 T-튜브 삽입 전 기관절개술 유무는 T-튜브 제거에 상당한 영향을 미치나 다변량 분석에서는 성별만이 T-튜브 제거 성공의 표지자로 밝혀졌다. 성별 (p=0.033)과 이전의 기관절개술(p=0.036)은 T-튜브 제거 성공군과 실패군 간의 2가지 다른 요소였다. 결론: T-튜브는 여러 원인에 의해 유발된 기관 협착에서도 믿을 만한 기도유지를 제공하였다. T-튜브는 중단기 동안 기관협착의 치료에 안전하고 효과적인 방법이라고 생각된다.

Keywords

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