Les stenoses tracheales acquises: Experiencede l’hopitalhabibthameur

Abstract

Introduction: Acquired tracheal stenoses represent rare but serious disease. They are often secondary to inappropriate management of patients under artificial ventilation. The goal of this study is to evaluate our results in the management of these stenoses and to assess the benefits and the limits different therapeutic means.

Materials and methods : We carry a retrospective study about 18 cases of acquired tracheal stenoses treated and followed in our department between 1999 and 2006. Initial endoscopic and radiological explorations have been performed in all cases. Treatment of the stenoses was medical, endoscopic and/or surgical. Follow-up was clinical and endoscopic
with a mean period of 22 months.

Results : All patients were victims of pathology needing intubation. Tracheotomy was performed after intubation in 50% of cases after a mean period of 12 days (5-20 days). Dyspnea and dysphonia were the major functional symptoms. Initial endoscopy showed a double tracheal stenosis in one case. Stenoses were initialy fibrous in 72.2% of cases and evolutive
in 27.8% of cases. CT scan performed in 12 cases and MRI in 2 others allowed to better study stenosis characteristics. RFE was performed in 6 cases and showed an obstructive syndrome in all of them. All patients received medical treatment. Before a definitive treatment, dilatation was performed in 11 cases (61%) and stenting in one other (5.6%). Laser diode therapy was used in 11 patients including 2 cases having postoperative recurrence. Tracheal resection and reconstruction was
performed in 11 cases (61%) having extensive and severe stenoses with involvement of tracheal cartilage.

Conclusion : Acquired tracheal stenoses represent a serious complication with high morbidity. If tracheal resection and reconstruction remains the gold standard treatment, endoscopy represents now a major alternative in their management. Nevertheless, prevention should be considered, given that most stenoses are iatrogenic due to traumatic or prolonged
intubations.