Improving the methods of reconstructive plastic surgery, the emergence of new algorithms for managing patients, the development of pharmacology have significantly improved the results of treatment of patients with cicatricial stenosis of the larynx and cervical trachea; however, the problem continues to be relevant since the outcome of treatment is not always satisfactory. The presence of chronic respiratory failure (which often accompanies cicatricial stenosis of the respiratory tract) as well as the lack of supporting viable cartilaginous structures of the larynx and trachea aggravates the course of the disease and requires a differentiated approach to the treatment of extended cicatricial laryngotracheal stenosis. The article analyzes the effectiveness of an integrated approach to the treatment of patients with extended laryngotracheal cicatricial deformity of the lumen using allogeneic graft as well as the correction of respiratory disorders and post-hypoxic tissue changes using inhalations of a heated helium-oxygen mixture in the perioperative period. The study included 20 patients with an age interval of 20–65 years and a disease duration of 1–12 years. At the outpatient stage, the necessary clinical and radiological, endoscopic, and functional examination was carried out. To detect chronic respiratory failure, the gas and acid-base composition of the blood was studied. In the hospital, all patients underwent reconstructive plastic surgery using allogeneic graft. All patients at the pre- and postoperative stage received inhalations with a heated helium-oxygen mixture according to the developed algorithm. The study showed that an integrated approach to the treatment of patients with extended laryngotracheal cicatricial stenoses is an effective method leading to good functional results of surgical treatment, reducing the time of postoperative wound regeneration and improving the quality of life of patients.
Objectives. The article summarizes the indications for surgical tracheostomy (STS) and puncture dilatation tracheostomy (PDT) in patients who underwent mechanical ventilation in the intensive care units (ICU). Based on analysis of 502 case histories, the advantages and disadvantages of different types of tracheostomies were determined. The microbiota of the tracheobronchial tree of 40 patients after PDT was studied, the algorithm of postoperative management of patients who underwent tracheostomy in the ICU was described. We also reviewed endoscopic diagnostic and treatment methods for postintubation changes in the larynx and trachea and the main aspects of postoperative care. The revised approach to decannulation of patients allowed to reduce the duration of hospital stay.Results: Among patients after PDT (group 1; n = 164), 25 complications (15.2 %) were observed. Intraoperative complications (n = 4, 16 %): 3 technically difficult cases (12 %), when PDT had to be continued as an open surgical procedure; 1 case (4 %) of subcutaneous emphysema. Postoperative complications (n = 21, 84 %): 4 cases (16 %) of tracheoesophageal fistulas (TEF), 2 cases (8 %) of tracheomediastinal fistulas(TMF), 2 cases (8 %) of bleeding, 2 cases (8 %) of bilateral paresis of the larynx and 2 cases (8 %) of grade III ulcerative tracheitis, 6 cases (24 %) of a granulation process in the cervical trachea; 3 patients (12 %) required retracheostomy in the late postoperative period. According to the microbiological study, Klebsiella pneumoniae and Pseudomonas aeruginosa prevailed on days 1–3, Proteus mirabilis and Acinotobacter sp. on days 5–7, and Candida sp. was noted on day 10. Among patients after STS (group 2; n = 338), complications were noted in 20 (5.9 %), including 3 (15 %) intraoperative: 1 case (5 %) of pneumothorax, 2 cases (10 %) of damage to the membranous wall of the trachea with thedevelopment of TMF. Postoperative complications were observed in 17 cases (85 %), including 4 cases (20 %) of tracheal stenosis, 2 cases (10 %) of retracheostomy; 2 cases (10 %) of TMF; 3 cases (15 %) of a granulation process in the tracheostomy area, 1 case of bilateral paresis of the larynx (5 %), 3 cases (15 %) of grade III ulcerative tracheitis; 1 case (5 %) of mucosal pressure ulcer of the upper third of the posterior wall of the trachea, 1 case (5 %) of TEF.
This article analyzes the increasing effectiveness of extensive defects and chronic cicatricial laryngeal and tracheal stenosis treatment with the allogeneic cartilage implantation. The study included 63 patients with an age interval of 18–65 years and a disease duration from 3 months to 6 years. Radiologic, functional and endoscopic investigations were carried out, after which the patients underwent laryngotracheoplasty using allogeneic cartilage, which has low antigenicity, affects the growth of the recipient’s tissues and prevents scarring. After the discharge, a dynamic outpatient observation was carried out: 2 times a week – 10 days; once a week – 21 days, once a month - 6 months. The study revealed that a differentiated approach to the treatment of patients with stenosis of the laryngeal-tracheal complex using the allogeneic cartilage made it possible to fully rehabilitate of 59 (94%) of 63 patients (100%). Only 4 (6%) patients had partial resorption or rejection of implanted cartilaginous allografts that led to the failure of the laryngeal and tracheal walls in the late postoperative period. The use of the allogeneic cartilage implantation in reconstructive surgery has proved to be highly effective in the laryngeal and tracheal framework defects, resulted from prolonged stenosis, major surgical interventions, and trauma.
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