1 "The role of tracheal stenting in the alternative treatment of tracheal stenosis" Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN
41
Embed
1 "The role of tracheal stenting in the alternative treatment of tracheal stenosis" Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital,
This document is posted to help you gain knowledge. Please leave a comment to let me know what you think about it! Share it to your friends and learn new things together.
Transcript
1
"The role of tracheal stenting in the
alternative treatment of tracheal stenosis"
"The role of tracheal stenting in the
alternative treatment of tracheal stenosis"
Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN
Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN
Bagheri. R. MD Assistant professor of thoracic surgery, Quaem hospital, Mashad, IRAN
Bannazadeh M. MD Assistant professor of thoracic surgery, Valiasr Hospital, Tehran, IRAN
2
Etiology of tracheal stenosisEtiology of tracheal stenosis Etiology of tracheal stenosisEtiology of tracheal stenosis
• Common cause: Common cause: (a)(a) Prolonged intubationProlonged intubation
(b)(b) Tracheal tumor (benign or malignant)Tracheal tumor (benign or malignant)
Treatment of tracheal stenosisTreatment of tracheal stenosis
• The best method of treatment is tracheal The best method of treatment is tracheal resection.resection.
• Tracheal surgery demands very skilled Tracheal surgery demands very skilled surgeons.surgeons.
• The most important complication of tracheal The most important complication of tracheal resection is tracheal stenosis.resection is tracheal stenosis.
• The best method of treatment in posttracheal The best method of treatment in posttracheal resection stenosis is repeated tracheal resection stenosis is repeated tracheal resection.resection.
• The best method of treatment is tracheal The best method of treatment is tracheal resection.resection.
• Tracheal surgery demands very skilled Tracheal surgery demands very skilled surgeons.surgeons.
• The most important complication of tracheal The most important complication of tracheal resection is tracheal stenosis.resection is tracheal stenosis.
• The best method of treatment in posttracheal The best method of treatment in posttracheal resection stenosis is repeated tracheal resection stenosis is repeated tracheal resection.resection.
4
Material & methodMaterial & method
• This is a prospective study (case series) This is a prospective study (case series) in patients with tracheal stenosis who in patients with tracheal stenosis who weren’t candidate for tracheal surgery in weren’t candidate for tracheal surgery in Tehran Vali Asr hospital from 2001 to Tehran Vali Asr hospital from 2001 to 2003.2003.
• Patient selection : Patient selection : (1)(1)Inoperable tracheal malignancy Inoperable tracheal malignancy (2)(2) Non tumoral stenosis which is complicated with Non tumoral stenosis which is complicated with previous surgery previous surgery (3)(3)Inability to stand a major operation (poor general Inability to stand a major operation (poor general condition or CNS problem)condition or CNS problem)
5
Method of studyMethod of study
• Patient’s that Exclude from study:Patient’s that Exclude from study:
(1)(1) Inability to perform rigid Inability to perform rigid bronchoscopy (vocal cod paralysis) bronchoscopy (vocal cod paralysis)
(3)(3) Follow up less than 6 monthFollow up less than 6 month
6
Stent propertiesStent properties
• Polyflex stent with introducer systemPolyflex stent with introducer system• Silicon stent with polyester mesh for Silicon stent with polyester mesh for
maintaining airway patencymaintaining airway patency• Size : inner diameter : 6-22 mm in 2 mm steps Size : inner diameter : 6-22 mm in 2 mm steps
length : 20-80 mm in 10 mm stepslength : 20-80 mm in 10 mm steps
7
Appropriate stent sizeAppropriate stent size
• Stent internal diameter: Maximum size of tracheal dilation with rigid bronchoscope +3mm +4mm
• Stent length: length of stenosis +2cm
8
Technique of stent insertionTechnique of stent insertion
9
Technique of stent insertionTechnique of stent insertion
10
Technique of stent insertionTechnique of stent insertion
11
Technique of stent insertionTechnique of stent insertion
12
Technique of stent insertionTechnique of stent insertion
13
Technique of stent insertionTechnique of stent insertion
14
Technique of stent insertionTechnique of stent insertion
15
Technique of stent insertionTechnique of stent insertion
16
Technique of stent insertionTechnique of stent insertion
17
Technique of stent insertionTechnique of stent insertion
18
Technique of stent insertionTechnique of stent insertion
19
Technique of stent insertionTechnique of stent insertion
20
Internal view of trachea after Internal view of trachea after stent insertionstent insertion
21
Radiography of patient after Radiography of patient after stent insertionstent insertion
22
Radiography of patient after Radiography of patient after stent insertionstent insertion
23
Result of study Result of study
24
Age frequency Age frequency
50 to 59 y50 to 59 y
16.67%16.67%
1010 to 19 y to 19 y
8.33%8.33%
20 to 29 y20 to 29 y
41.67%41.67%
40 to 49 y40 to 49 y
8.33%8.33%
30 to 39 y30 to 39 y
25%25%
25
Sex frequency Sex frequency
Female Female
33.33%33.33%
Male Male
66.67%66.67%
26
The cause of tracheal stenosis The cause of tracheal stenosis
Tracheal Tracheal malignancymalignancy
16.67%16.67%
Chemical Chemical gas gas
inhalationinhalation
8.33%8.33%
Post intubationPost intubation
75%75%
27
Time between extubation and beginning Time between extubation and beginning of symptom’s of stenosis of symptom’s of stenosis
31 to 45 31 to 45 daysdays
22.22%22.22%
0 to 15 days0 to 15 days
22.22%22.22%
16 to 30 16 to 30 daysdays
55.66%55.66%
28
Internal diameter of stenosisInternal diameter of stenosis
percent Frequency Internal diameter of stenosis
50.00%60 to 0.5 cm
25.00%30.51 to 0.6 cm
25.00%30.61 to 0.7 cm
100.00%
12Total
29
Evaluation of stent efficacy Evaluation of stent efficacy (A)(A) Clinical symptoms: Clinical symptoms: 1.1. Improvement of stridor Improvement of stridor 2.2. Activity of patientActivity of patient
Percent Frequency Activity of patient
16.67%2Excellent
66.67%8Good
16.67%2Intermediate
0.00%0Fair
100.00%12Total
30
Evaluation of stent efficacyEvaluation of stent efficacy
Percent Frequency One month after stent
insertion
16.67%2Excellent
50.00%6Good
33.33%4Intermediate
0.00%0Fair
100.00%12Total
31
Evaluation of stent efficacyEvaluation of stent efficacy
Percent Frequency Two weeks after stent removed
0.00%0Excellent
18.18%2Good
9.09%1Intermediate
72.73%8Fair
100.00%11Total
32
Evaluation of stent efficacyEvaluation of stent efficacy
(B) Paraclinic study : (B) Paraclinic study : 1.1. P.F.T (before and after stental inserties)P.F.T (before and after stental inserties)2.2. Peakflowmetry (before and after stental inserties)Peakflowmetry (before and after stental inserties)
Displacement Displacement of 3 columned of 3 columned
8.33%8.33%Displacement Displacement
of 1 of 1 columned columned
33.33%33.33%
DisplacemeDisplacement of2 nt of2
columned columned
58.33%58.33%
33
Stenting complications Stenting complications
Without Without complicatiocomplicatio
n n
25%25%
With With complication complication
75%75%
34
Stenting complicationStenting complication
Late Late
77.78%77.78%
Intera operative Intera operative
11.11%11.11%
Immediately Immediately
11.11%11.11%
35
Late complication Late complication
77.78%
Granulation tissueGranulation tissue Retention Retention of of
secretionsecretion
Automatic Automatic stental stental
extrusionextrusion
Mouth bad smellMouth bad smell Tumoral Tumoral growthgrowth
44.44%
11.11% 11.11% 11.11%
0
10%
20%
30%
40%
50%
60%
70%
80%
36
Duration of stenting Duration of stenting
0 to 30 0 to 30 daysdays
20%20%
31 to 60 days31 to 60 days
20%20%
61 to 90 days61 to 90 days
30%30%
91 to 120 91 to 120 daysdays
30%30%
37
Cause of stent removalCause of stent removal
(A)(A) In benign disease : In benign disease :
The stent was removed in 30% of The stent was removed in 30% of patients in ideal time (3 to 4 month) patients in ideal time (3 to 4 month) without complication but in 70% of without complication but in 70% of patients because of some patients because of some complications we removed had to complications we removed had to stent obligatory in less than 3 month.stent obligatory in less than 3 month.
38
Cause of early stent removal Cause of early stent removal
Mouth bad Mouth bad smellsmell
14.29%14.29%
granulatiogranulationn
85.71%85.71%
39
Cause of stent removalCause of stent removal
(B) In malignancy : (B) In malignancy :
In one patient stent was kept in place In one patient stent was kept in place until death time but in one patient until death time but in one patient because of tumoral ingrowth at first the because of tumoral ingrowth at first the stent was removed and after rigid stent was removed and after rigid bronchoscopy, tumor removed and the bronchoscopy, tumor removed and the stent replaced again and patient was stent replaced again and patient was reffered to radiotherapy. reffered to radiotherapy.
40
conclusionconclusion
• Stent removal in benign conditions Stent removal in benign conditions showed signs of recurrence which showed signs of recurrence which needed another alternative treatment. needed another alternative treatment. This problem makes the role of stent This problem makes the role of stent insertion questionable. But the use of insertion questionable. But the use of stent in malignant conditions is stent in malignant conditions is indicated where it is the only indicated where it is the only alternative, and its role is approved.alternative, and its role is approved.