1 / 17

Alper Toker, Serkan Kaya, Serhan Tanju, Yusufhan Süoğlu, Mustafa Ererel,

Interventions other than tracheostomy in subglottic and tracheal pathologies. What did we do in the last 5 years ?. Alper Toker, Serkan Kaya, Serhan Tanju, Yusufhan Süoğlu, Mustafa Ererel, Şükrü Dilege, Göksel Kalaycı Istanbul Medical School. Aim.

jack-park
Download Presentation

Alper Toker, Serkan Kaya, Serhan Tanju, Yusufhan Süoğlu, Mustafa Ererel,

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript


  1. Interventions other than tracheostomy in subglottic and tracheal pathologies. What did we do in the last 5 years? Alper Toker, Serkan Kaya, Serhan Tanju, Yusufhan Süoğlu, Mustafa Ererel, Şükrü Dilege, Göksel Kalaycı Istanbul Medical School

  2. Aim • Changing concepts in tracheal dieseases: 1990 • Resections • Endobronchial treatment modalities • Stenting • Hybride techniques • Our approach to tracheal disease in the last 5 years.

  3. Patients and Methods • Jan 2002 – Jan 2007 • 62 patients, subglottic-tracheal obstructions • Postintubation tracheal stenosis: 36 patients • Secondary tracheal tumors: 16 patients • Primary tracheal tumors: 6 patients • Tracheosephageal fistula: 4 patients Age, sex, type of operation, reintervention, morbidity, mortality

  4. Patients • 48 male, 14 female, • Mean age: 48.3 years (7-84 years) • Previous tracheal intervention: 24 patients • Trachea resections • Tracheal stenting • Tracheostomy • Intubation • TEF Division • Primary admission 38 patients

  5. Patients before Jan 2002 8 tracheal resections and end to end anastomosis16 tracheal stenting Excluding Criterias • Operations in ENT Department: • Tracheal resections and end to end anastomosis • Tracheal reconstructions and plasty operations • Montgomary –T tube • Interventions in Department of Pulmonary Diseases • Endo Tracheal – Endo Bronchial treatment • Stenting

  6. Emergency First intervention - reintervention • Bronchoscopy in all patients • Dilatation in BTS • Endoluminal tumor: Cautery, argon, cryotherapy • Stenosis that does not permit dilatation:Tracheostomy • Dilatation – stenting: Primary – Complication treatment • Endoluminal therapy – stenting: Primary – complication treatment

  7. Dilatation and resection relations in BTS • Resection: after CT and Tracheoscopy • 13 patients • Dilatations and immediate resection • 12 patients • Technically easy, • Good risk patients, • Timing, • No inflamation. • Dilatation – reevaluation and resection • 6 patients • Odematous trachea, • Technically difficult, • Comorbidity, • A new CT is a must, • Previous interventions. 29 tracheal resection 1 reresection

  8. Tracheal resections • 24 Benign tracheal -subglottic stenosis • 1 Primary tracheal tumors • 1 Secondary tracheal tumor • 3 Benign tracheosephageal fistulas Laryngeal release manuever: 4 patients (Suprahyoid release) Length of resection: 1cm - 5 cm

  9. Tracheal resectionImmediate postoperative and early postoperative complications • Immediate postoperative complications (24 hours) • 2 emergency tracheostomy -1 hemorrhage • Early complications (24 hours – 10 days) • 4 patients with infections Cord vocal paralysis :Unilateral (symptomatic and diagnosed 4 patients) Bilateral (1 patient)

  10. Late postoperative complications (10 days) 6 patients restenosis • Multiple dilatations • Dilatation Stenting: 1 patients - removed – no problem • Montgomary T tube 1 patient, • Argon laser 3 patient – no problem • Reresection 1 patient – no problem In tracheal resections 1 patient died: TEF – Fistula division - stenting - septic shock: Resection anastomosis- osephageal primary repair: mediastinitis - sepsis

  11. Tracheal resections done in other centers • 1 patient: tracheal stenting • 1 patient: Montgomary T tube – Removed in the first year – no problem • 1 patient: Montgomary T tube – Multiple granulation tissue – Multiple endobronchial treatment – trachea perforasyonu - Hybrid interventions – Restenosis : Tracheostomy

  12. Hybride interventions

  13. Interventions other than resections employed in other centers: 21 patients • Tracheal stenting: 4 patients • Tracheostomy:13 patients • Endobronchial treatment: 2 patients • Tracheaosephageal fistula division 2 patients

  14. Stenting • Stenting as a primary treatment • 8 patients: 4 patients with endobronchial treatment • 4 patients after dilatation • Stenting as a complication treatment • 6 patients: 2 patients after endobronchial treatment • 4 patients after dilatationsonrası tedavi • Complications and mortality • Tracheostomy: 2 patients: Stenting as a primary treatment • Postobstructif negative pressure lung edema:2 patients (12-24 hour intubation) • 1 patient died of febrile neutopenia –sepsis

  15. Results • After Tracheal resection – stenting: 24 patients had multiple interventions; • Patients who had primary intervention in our hospital had a mean of 1.24 intervention. • Patients who had primary intervention in other centers had a mean of (excluding the primary intervention) 2.14 intervention. • Two patients died in hospital period. • 44 of the interventions were emergency, 36 were semi-emergency.

  16. Discussion 1- Is stenting true in benign tracheal disease ? Or should it be resection ? Stenting : Duration Type of the stent General health and social condition, Literature: results (%24 Dumon 1996)(%26Martinez1996) (%17Brichet 1999) (%27 Puma 2002) 2- Could stent be a bridge to real treatment ? 3- Monodisciplinary ? Multidisciplinary airway team ?

  17. Multidisciplinary airway team • Laryngeal examination, • Augmentaton of vocal cords, • Laryngeal release manuevers • Rigid Bronchoscopies • Flexible Bronchoscopies • Endobronchial treatment • Post operative care ENT Clinics Pulmonary Departments Chest Surgery Clinics Anesthesiology and intensive care unit Speech therapists

More Related