Objective To investigate the application and long-termresults of epiglottic in reconstruction of the traumatic laryngotracheal stenosis.Methods From January 1988 to February 2002, 42 patients with traumatic laryngotracheal stenosis were treated, including 33 laryngeal stenosis and9 laryngotracheal stenosis. The following surgical treatment were performed: ① lowered epiglottic andbi-pedicled sternohyoid myofascial flap and ② lowered epiglottic and bipedicledsternohyoid myofascial flap and sternocleidomastoideus clavicle membrane flap. Results Thirty-seven patients(88.1%) were successfully decannulated 10 to 75 daysafter operation. Feeding tube lasted from 9 to 24 days, all the patients rehabilitated deglutition after surgery. The time of using stent was 9 to 19 days in 25cases.All patients were followed up 1 year to 3 years and 4 months. The function of larynx recovered completely in 37 decannulated patients and partially in 5cannulated patients. Conclusion Epiglottic- has the advantages of easy gain, high antiinfection and survival rate, and stable structure. A combination of epiglottic and the bipedicled sternohyoid myofascial flap plus sternocleidomastoideus clavicle membrane flap can repair large laryngeal and tracheal defects.
ObjectiveTo establish a simple and stable model of benign tracheal stenosis in SD rats by nylon brush scraping induced mechanical injury, and to observe the pathological changes of tracheal tissue at different time points after modeling.MethodsTwenty SD rats were divided into sham operation group (10 rats) and stenosis model group (10 rats) by random number method. Symptoms and survival conditions were observed, tracheal tissues were obtained, granulation tissue proliferation was observed, and stenosis indexes were measured and compared. Another fifteen rats were sacrificed at different time points (days 0, 2, 4, 6, and 8) after modeling. Tracheal tissues were obtained, HE staining and Masson staining were performed to observe pathological changes with time.ResultsThe survival rate of the sham operation group was 100% on the 8th day after operation, and the survival rate was 0% on the 8th day after operation in the stenosis model group. The difference in survival condition between the two groups was statistically significant (P=0.000 1) by Log-rank test. The stenosis index in the sham operation group was (6.12±1.78)%, and in the stenosis model group was (60.28±12.56)%. The difference in the stenosis between the two groups was statistically significant (P<0.000 01). HE staining results showed that the tracheal lumen was unobstructed and no granulation tissue hyperplasia or stenosis was found in the sham operation group. The epithelial mucosa was intact and smooth, and the cilia structure was clearly visible. It was a pseudo-stratified ciliated columnar epithelium, which was consistent with the characteristics of normal airway mucosa. While in stenosis model group, the lumen was significantly narrowed, and the stenosis was mainly caused by granulation tissue hyperplasia. No epithelial structure was observed, or epithelial structure was extremely abnormal. Masson staining showed that the fibroblasts in the injured site increased first and then decreased, and the collagenous fiber (blue) in the injured site gradually increased with time.ConclusionsA model of benign tracheal stenosis in rats can be successfully established by nylon brush scraping induced mechanical injury. The modeling method is simple, controllable and reproducible. The model can be widely used in the investigation of pathogenic mechanism for benign airway stenosis and efficacy exploration of new treatment.
Objective To investigate the efficacy and influential factors of interventional therapy for post-intubation tracheal stenosis. Methods The clinical data of 69 patients with tracheal stenosis after tracheal intubation in the First Affiliated Hospital of Guangzhou Medical University from February 2010 to March 2015 were retrospectively analyzed. The effects of interventional treatment for tracheal stenosis after intubation were evaluated by reviewing the medical records and telephone follow-up for more than 1 year. Multivariate logistic regression model was used to analyze the influential factors. Results The study recruited 69 patients with the median age of 44 years. After the interventional treatment, ATS dyspnea score decreased from (2.41±0.76) points to (0.65±0.62) points ( P<0.01), the diameter of airway lumen increased from (4.24±2.05)mm to (10.57±3.14)mm ( P<0.01). The short-term effective rate of interventional therapy was 92.8% (64/69) but the restenosis rate in 1 month, 3 months and 1 year after interventional treatment were 56.5%, 26.1% and 36.2%, respectively. Multivariate logistic regression analysis showed that diabetes (OR=2.819, 95%CI 1.973-4.062）, shortness of breath score >3 points (OR=13.816, 95%CI 5.848-32.641）, trachea stenosis diameter <4.5 mm (OR=7.482, 95%CI 4.015-13.943), tracheal stenosis grade ≥4 (OR=3.815, 95%CI 2.258-6.447), stenosis in the upper trachea (OR=5.173, 95%CI 3.218-8.316) were risk factors of interventional therapy for post-intubation tracheal stenosis. Conclusions The general efficacy of interventional treatment for tracheal stenosis after tracheal intubation is poor, and the recurrence rate is still high. The high degree of tracheal stenosis, diabetes mellitus and upper tracheal stenosis are important factors that affect the efficacy of respiratory interventional therapy.
Objective To explore the feasibility and safety of extracorporeal membrane oxygenation (ECMO) to support the airway reconstruction for the patients with airway obstruction or stenosis who cannot be ventilated routinely. Methods There were 3 patients received trachea reconstruction procedures assisted by ECMO. Among the patients, 2 cases with tracheal neoplasms underwent fibrobrochoscopy treatments, another one with endotracheal stenosis and fistula received tracheoplasty and semi-tracheostomy. Results ECMO can provide enough oxygenation for the patients with airway obstruction or stenosis and more time for advanced therapies. All three patients recovered after interventional surgeries, in whom one case died due to multiple organ failure caused by esophageal carcinoma metastasis after 3 months, and the others survived with dyspnea classification of 2-3 grade. Conclusion ECMO can be a safe and effective approch for the patients who cannot be ventilated conventionally in airway reconstruction.
ObjectiveTo investigate the expression of histone deacetylase 2 (HDAC2) in animal model of benign tracheal stenosis, and explore the mechanism of HDAC2 in development of tracheal stenosis.MethodsEighteen rabbits were randomly divided into a blank control group, a model group, and an erythromycin group, with 6 rats in each group. The model group and the erythromycin group underwent tracheostomy, the inner wall of trachea was brushed back and forth with a nylon brush for more than 20 times to induce benign tracheal stenosis. From 7 days before surgery to 9 days after surgery, the model group received gavage with saline, the erythromycin group received gavage with low-dose erythromycin in dose of 15 mg·kg–1·d–1, and the control group did not receive any treatment. On the 10th day after operation, all the rabbits were sacrificed and the trachea was cut to measure the tracheal stenosis. RNA and protein were extracted from the granulation tissue in the stenosis and the relative mRNA expressions of HDAC2, interleukin (IL)-6 and IL-8 in the granulation tissue were detected by real-time fluorescence quantitative PCR. The relative expression of HDAC2 protein was detected by Western blot.ResultsCompared with the blank control group, the tracheal stenosis in the model group was more obvious [(84.60±1.14)% vs.(27.00±6.44)%], the mRNA and protein expressions of HDAC2 were decreased (0.29±0.07 vs. 1.00±0.00, 0.20±0.02 vs. 0.49±0.04), the mRNA expressions of IL-6 and IL-8 were up-regulated (4.22±0.67 vs. 1.00±0.00, 162.72±23.23 vs.1.00±0.00). Compared with the model group, tracheal stenosis in the erythromycin group was relieved [(64.00±12.25)% vs. (84.60±1.14)%], the mRNA and protein expressions of HDAC2 were increased (0.42±0.14 vs. 0.29±0.07, 0.43±0.01 vs. 0.20±0.02), the mRNA expressions of IL-6 and IL-8 were decreased (0.72±0.24 vs. 4.22±0.67, 130.22±7.93 vs. 162.72±23.23). All the differences were statistically significant (all P<0.05). The Pearson correlation coefficient between tracheal stenosis and HDAC2 mRNA relative expression was –0.96 (P<0.05).ConclusionsThe down-regulation of HDAC2 expression in model of benign tracheal stenosis is related to the occurrence and development of tracheal stenosis. The low dose of erythromycin may be used to treat benign tracheal stenosis by up-regulating expression of HDAC2 and thus inhibiting the inflammatory disorder during tracheal injury repair.
Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages, disadvantage, and indication of each material. Methods The cl inical data were retrospectively analyzed, from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006. There were 229 males and 108 females aged from 2 to 54 years (median, 23.5 years). According to Cotton’s grading criteria for laryngotracheal stenosis, there were 94 cases of grade II, 218 cases of grade III, and 25 cases of grade IV, and all accompanied by laryngotracheal framework defect of 1-5 cm. The costal cartilage autograft was performed in 157 cases, thyroid cartilage graft in 27 cases, nasal septal cartilage graft in 8 cases, sternohyoid myocutaneous rotary door flap graft in 104 cases, hyoid bone flap of sternocleidomastoideus graft in 7 cases, musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases, hydroxyapatite artificial tracheal ring graft in 10 cases, and pedicle myocutaneous flap with “C” shape nickel-titanic alloy net graft in 3 cases. Silastic T-tube was used after reconstruction for 6-12 months. Results Infection occurred in 5 cases and the incisions healed by second intention, the others achieved healing of incision by first intention. Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases; they were all cured after symptomatic treatment. After operation, 4 cases failed to be followed up and 12 cases did not recover, including 6 cases of costal cartilage autograft, 1 case of hyoid bone flap of sternocleidomastoideus graft, and 5 cases of sternohyoid myocutaneous rotary door flap graft. A total of 321 patients were followed up for 1-10 years (mean, 3.5 years). The patients had no laryngotracheal restenosis with good swallowing function and respiratory function. Conclusion Different materials of laryngotracheal framework reconstruction have advantages and disadvantage respectively. The appropriate material should be selected according to the special details of pathological change, and the satisfactory curative effect may be obtained.
Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.
Congenital tracheal stenosis (CTS) is a rare but potentially life-threatening disease which results in congnital airway lesion. CTS is often associated with cardiovascular anomalies and presented with a wide spectrum of symptoms. CTS has challenged pediatric surgeons for decades. Various classic approaches and new techniques, including computational fluid dynamics, tissue-engineering trachea, and 3D printing have been proposed for diagnosis and treatment of CTS. This review provides a snapshot of the main progress of diagnosis and treatment of CTS.
Objective To summarize our clinical experience of side-slide tracheoplasty in surgical management of bridging bronchus associated with congenital tracheal stenosis(CTS) and congenital heart disease (CHD). Method We retrospectively analyzed the clinical data of 8 bridging bronchus patients associated with CTS and CHD underwent tracheoplasty in our hospital from January 2010 through June 2015. There were 3 males and 5 females at age of 19.6±9.1 months and weight of 9.9±5.4 kg in our hospital. It was found that main tracheal associated with intermediate bronchus stenosis in 4 patients. Complete tracheal rings or bronchial rings were identified in all cases. Less than 50% normal tracheal size was found in all patients. Correction of CHD and tracheoplasty were done under cardiopulmonary bypass at the same stage. The technique of side-slide tracheoplasty was used in all patients. Results Average cardiopulmonary bypass time was 64.0±24.1 min. Average aortic clamp time was 14.0±18.1 min. No operative death occurred in hospital. The average duration of postoperative hospital stay was 20 d. Follow-up was completed in 8 patients. The duration of follow-up was 1 month to 5 years. Tracheal granulation occurred in one patient after six weeks of postoperation. The clinical symptoms improved significantly in the remaining patients. Conclusions Bridging bronchi has special anatomical features. The technique of side-slide tracheoplasty can be used to correct bridging bronchus associated with CTS with satisfactory outcomes.