POSSIBILITIES OF RESECTION AND RECONSTRUCTIVE-PLASTIC SURGICAL PROCEDURES IN LARYNGO-TRACHEAL, MULTIFOCAL AND EXTENSIVE CICATRICIAL STENOSIS OF TRACHEA

Main issues of treatment of patients with scar stenosis of trachea (SST) are to increase its efficacy and safety, as well as to determine indications and contraindications for circular resection and reconstructive interventions on the trachea in patients with extended lesions of respiratory tract, with stenoses involving subvocal cords part of larynx and well as multifocal narrowing of the trachea which could improve treatment results and quality of life of patients, to gain recovery and reduce disability and mortality. Material and methods. Ninety two patients aged from 11 to 62 years with SST were surgically treated. Localization of stenoses: in the upper third of the trachea in 42 (45,6%) patients, narrowing of the intrathoracic part of trachea in 14 (15,2%) , laringotraheal lesion localization with subglottic larynx and upper third of trachea in 22 (23,9%), combined lesion of the larynx and intrathoracic part of trachea in 6 (6,5%), scar narrowed cervical and thoracic trachea (7,6%) in 7 patients. Six (6,5%) patients had complete obliteration of the trachea lumen with scar over tracheostomy cannula. Five (5,4%) patients came from other centers with postoperative anastomotic stenoses of the trachea after circular resection. Stenotic site length in patients varied from 0,3 to 7 cm. Most frequently (64,2%), SST length of more than 2 cm was observed. Results. In critical and decompensated stenosis with diameter of SST up to 5 mm with the threat of asphyxiation by the first stage, we used endoscopic laser-and electric destruction of constriction followed by restricted zone bouging. If long-term rehabilitation was necessary and in case of absence of the conditions to the implementation of circular tracheal resection, we used tracheal stents Dumont type (12 patients). Circular resection of the trachea was performed in 24 patients. In case of contraindications, 28 patients underwent reconstructive plastic surgery withdissection the stenosis, excision of scar tissue and formation of trachea lumen in T-shaped stent. After removing T-shaped endoprosthesis, plasty of anterior tracheal wall and of soft tissues of the neck defects was performed using local tissues and grafts with microsurgical techniques. Conclusions. 1. Patients with SST should undergo multimodal approach depending on degree and localization of narrowing, length and levels of restriction, taking into account severity of associated pathologies using complex of endosurgical, resection and reconstructive treatments. 2. When an extended SST involvement in the process is more than 30-50% of the trachea up to 5-6 cm, it’s possibly to perform circular tracheal resection provided that mobilization of necessary levels is sufficient. 3. In case of multifocal SST in conjunction with subglottic stenosis of the larynx formation of the lumen, it is expedient to form a lumen in the T-shaped endoprosthesis.

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