RESUMO
Introducción: la estenosis traqueal corresponde a una complicación común, secundaria a la intubación o a la traqueotomía. Existen varias modalidades en cuanto a su tratamiento, por eso nos propusimos evaluar los resultados del tratamiento de la estenosis traqueal isquémica mediante fotorresección con Nd-YAG láser. Métodos: se realizó un estudio prospectivo descriptivo en 160 pacientes, con estenosis traqueal isquémica operados en el Servicio de Otorrinolaringología del Centro de Investigaciones Médico-Quirúrgicas, en el período comprendido de enero de 1987 hasta diciembre del 2010. Se clasificó a las estenosis traqueales postintubación, en 5 grupos, según Luis Rocabado y otros. El método diagnóstico empleado fue la broncoscopia. Los pacientes admitidos en el estudio tenían traqueotomía y fueron clasificados en grupo I y II. Como proceder quirúrgico se realizó fotorresección con Nd-YAG láser y colocación de cánula en T de Montgomery. Los enfermos se valoraron clínica y endoscópicamente al alta y posteriormente en consulta externa durante un período de 1 año. Resultados: el mayor porciento de los pacientes corresponde al sexo femenino. El rango de edad fue entre los 30 y 49 años con una desviación estándar de 36,7 ± 5,0 años. Se clasificaron 93 (58,1 por ciento) pacientes en el grupo I y 67 (41,9 por ciento) en el grupo II. La causa más frecuente de intubación endotraqueal prolongada, fue el politrauma. Se complicaron 13 pacientes, con una mortalidad de 2,5 por ciento. El resultado final se evaluó como bueno en 94 pacientes (58,7 por ciento), satisfactorio en 53 (33,2 por ciento) y malo en 9 (5,6 por ciento). Conclusiones: el tratamiento inicial para las estenosis traqueales isquémicas clasificadas como grado I y II debe ser por vía endoscópica con Nd-YAG láser(AU)
Introduction: Tracheal stenosis is a common complication secondary to intubation or to tracheostomy. There are several treatment modalities to face this problem, hence we suggested that the results of the treatment of ischemic tracheal stenosis be evaluated based on photoresection with Nd-YAG laser. Methods: A prospective descriptive study was performed in 160 patients, who suffered ischemic tracheal stenosis and had been operated on at the Otolaryngology Service of the Medical and Surgical Research Center (CIMEQ) in the period from January 1987 to December 2010. Post-intubation tracheal stenosis was classified in five groups, according to Luis Rocabado et al.'s classification. The diagnosing method was bronchoscopy. All the patients included in the study had tracheotomy and were classified into the group I and group II. The surgical procedure performed on patients was photoresection with Nd Yag laser and placement of Montgomery's T- stent. The patients were clinically and endoscopically evaluated at discharge and afterwards at the outpatient service for one year. Results: The highest percentage of patients was females. The age range was 30 to 49 years, with SD= 36.7 ± 5. 0 years. Ninety three (58.1 percent) were classified in group I whereas 67 (41.9 percent) were included in group II. The most frequent cause in extended endotracheal intubation was multiple trauma. Thirteen patients suffered complications; the mortality rate was 2.5 percent. The final result was evaluated as good in 94 (58.7 percent), satisfactory in 53 (33.2 percent) and negative in 9 (5.6 percent) patients. Conclusions: The initial treatment for ischemic tracheal stenoses classified as grade I and II should be endoscopic by using Nd-YAG laser(AU)
Assuntos
Humanos , Feminino , Adulto , Estenose Traqueal/terapia , Traqueotomia/métodos , Lasers de Estado Sólido/uso terapêutico , Broncoscopia/efeitos adversos , Epidemiologia Descritiva , Estudos ProspectivosRESUMO
Introducción: La estenosis traqueal congénita (ETC) es una entidad clínica infrecuente, que se caracteriza por la presencia de anillos traqueales circulares completos, que determinan estrechez fija del lumen traqueal ocasionando dificultad respiratoria de grado variable. Objetivos: Comunicar 10 pacientes portadores de ETC, sus aspectos clinicos, morfológicos y alternativas en el tratamiento. Pacientes y Método: Se analizó retrospectivamente las formas de manifestación, exámenes diagnósticos y evolución de diez pacientes portadores de ETC diagnosticados entre los años 1998 y 2006. Resultados: Seis pacientes con síntomas respiratorios graves requirieron cirugía correctora de la traquea, uno falleció luego de un año, en el postoperatorio de una intervención cardiovascular. Cuatro pacientes con sintomatología respiratoria menor no requirieron corrección quirúrgica, uno falleció en el postoperatorio de una cirugía cardiaca. Conclusión: La ETC es una malformación potencialmente grave que requiere tratamiento quirúrgico en los pacientes sintomáticos con obstrucción severa de vía aérea. Los pacientes con síntomas leves pueden permanecer en control y no ser sometidos a cirugía correctora.
Congenital tracheal stenosis (CTS) constitutes an uncommon disease, characterized by the presence of complete tracheal rings that determine a fixed narrow tracheal lumen with different levels of respiratory distress. Objective: To expose 10 patients with CTS in relation to their morphological-clinical aspects and treatment alternatives. Method: Retrospective analysis of these patients diagnosed with CTS between 1998 and 2006, in terms of clinical evolution and diagnostic exams. Results: 6 patients with severe respiratory symptoms needed corrective tracheal surgery; one of them died one year later during cardiac surgery. 4 patients with mild respiratory symptoms did not require tracheal surgery; one of them died during cardiac surgery. Conclusion: CTS is a serious malformation that requires surgical treatment in those patients with severe airway obstruction. Patients with mild symptoms are observed closely without the need for surgery.
RESUMO
Schwannoma is a rare benign tumor of the proximal tracheobronchial tree. The aim of the present study is to report a case of tracheal schwannoma causing airway obstruction. A 16-year-old woman complained of cough, wheezing and dyspneia. Bronchoscopy and computerized tomography showed a polypoide intratracheal mass obstructing approximately 80 percent of the lumen. The treatment consisted of tracheal resection and primary anastomosis. Histological analysis revealed a tracheal schwannoma. The postoperative course was uneventful and the patient remains well twelve months after surgery.
RESUMO
The contents of the present research is the result of experiments in dogs, substituting the third part of the tracheal length for bioprosthesis of homograft tracheas preserved in buffered glutaraldehyde at 2.5%. Fourteen mongreal dogs weighing between 10 and 20kg, had ortotopic implants of bioprosthesis by means of end-to-end anastomosis enveloped in a muscular flap (sternothyroideus e sternohyoideus). Post-operative clinic attendance, anatomopathological examinations, radiology and endoscopy were performed at the 7, 15, 30 and 45th days after the implantation.
O conteúdo do presente estudo é resultado da substituição de um terço do comprimento da traqueja de cães, por bioprótese de tecido traqueal homólogo preservado em glutaraldeído tamponado a 2,5%. Quatorze cães sem raça definida, pesando entre 10 e 20kg, receberam os implantes ortotópicos através de anastomose término-terminal, que em seguida foram envelopados com retalho muscular (sternothyroideus e sternohyoideus). Os animais foram acompanhados clinicamente durante o pós-operatório e as biopróteses avaliadas através de exames anatomo-patológicos, radiológicos e endoscópicos, no sétimo, décimo quinto, trigésimo e quadragésimo dia após a implantação.
RESUMO
The contents of the present research is the result of experiments in dogs, substituting the third part of the tracheal length for bioprosthesis of homograft tracheas preserved in buffered glutaraldehyde at 2.5%. Fourteen mongreal dogs weighing between 10 and 20kg, had ortotopic implants of bioprosthesis by means of end-to-end anastomosis enveloped in a muscular flap (sternothyroideus e sternohyoideus). Post-operative clinic attendance, anatomopathological examinations, radiology and endoscopy were performed at the 7, 15, 30 and 45th days after the implantation.
O conteúdo do presente estudo é resultado da substituição de um terço do comprimento da traqueja de cães, por bioprótese de tecido traqueal homólogo preservado em glutaraldeído tamponado a 2,5%. Quatorze cães sem raça definida, pesando entre 10 e 20kg, receberam os implantes ortotópicos através de anastomose término-terminal, que em seguida foram envelopados com retalho muscular (sternothyroideus e sternohyoideus). Os animais foram acompanhados clinicamente durante o pós-operatório e as biopróteses avaliadas através de exames anatomo-patológicos, radiológicos e endoscópicos, no sétimo, décimo quinto, trigésimo e quadragésimo dia após a implantação.