Side effects that have occurred in over 250 endobronchial laser treatments are reported. The laser has been used in severe tracheal and in bronchial obstructions. In two cases significant bleeding had to be treated with tamponade. In one patient an emphysema of the mediastinum developed, in 2 further patients a small pneumothorax. Perforation of the airway was not detected and no special treatment was necessary. Three patients with life-threatening tracheal stenoses and one patient with severe stenosis of both the mainstem bronchi due to metastasis in the bifurcation lymph node had a large defect in the tracheal or bronchial wall with a deep necrosis five to twelve weeks after laser treatment; all these patients had extensive radiotherapy in addition. One patient died due to severe respiratory insufficiency, probably caused by smoke intoxication. After the laser treatment, rubber-like fibrin-rich plaques may develop, which can lead to life-threatening obstructions of the airway. It is recommended that laser bronchoscopy should be performed with the rigid bronchoscope. After treatment of tracheal lesion an endoscopic check must be performed within 24 hours. The combination of laser treatment and radiotherapy seems to involve a certain risk of large defects in the bronchial wall due to necrosis of the tumour.

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Bei der operativen Behandlung der Trachealstenosen werden die Methoden der Fensterung, der Resektion mit Anastomose und Resektion mit Rekonstruktion beschrieben. Bei den Rekonstruktionen wird auf eigene Fälle mit dem Marlex-Netz verwiesen, welche aber postoperativ verstorben sind. Bei der Darstellung der Stenosen wird die Wertigkeit oder Valenz dieser betont, wobei das optische und röntgenologische Bild allein noch nicht genügen. Jeder Versuch einer Rekanalisation einer bedrohlichen Stenose ist wünschenswert (in der Zeit der Drucklegung wurden zusätzlich 4 Resektionen mit Anastomose durchgeführt). Ebenso wird die Bronchusanastomose sowohl beim Karzinom als auch bei narbigen Stenosen und beim Adenom empfohlen. Jede Anastomose ist auf längere Zeit obligatorisch zu bronchoskopieren. Resection of the trachea and large bronchi-Indications, methods and results. Fenestration, resection with anastomosis and resection with reconstruction have all been described in the operative treatment of tracheal stenosis. The author's personal experiences with reconstruction using Marlex mesh are reported. All the patients died postoperatively. The importance of the degree of stenosis is stressed whereby the optical and radiological aspects alone are not sufficient for evaluation of the severity. An attempt should be made to recanalise a threatening stenosis (during the time that this paper was in press 3 further resections with anastomses were carried out). Bronchial anastomsis is also recommended in carcinoma as well as in cicatricial stenosis and adenoma. It is essential that every anastomosis should be controlled bronchoscopically over a longer period.

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