Surgery of the trachea

Abstract

Experience with surgical treatment of 164 patients with various diseases of the trachea at the All-Union Institute of Clinical and Experimental Surgery in Moscow since 1963 is summarized. The main diagnostic methods used in tracheal diseases were tracheography and tracheoscopy with biopsy. Operations were performed for malformation, trauma, exflammatory disease, benign and malignant tumors, nontumoral stenoses, and esophagotracheal fistula. A bypass respiration system was used in the majority of patients after tracheal transection. Hyperbaric oxygenation added to the bypass respiration system made it possible to interrupt lung ventilation during operations on the trachea for long periods.The best operative approach to the thoracic trachea was a partial sternotomy and posterior thoracotomy. The standard approach to the tracheal bifurcation was a posterior right thoracotomy.The various operations performed on the trachea included sleeve resection with end-to-end anastomosis, resection of the tracheal bifurcation, window resection, tumoral incision in the opened trachea, plastic repair of esophagotracheal fistula, and strengthening of the membranous trachea. Six variations of resection of the tracheal bifurcation were performed. In cases of sleeve resection, operative risk was minimized by suturing the left main bronchial stump closed, leaving the left lung in a state of atelectasis.Of the 164 patients who underwent operation, 138 were discharged from the hospital and 26 (16%),died in the postoperative period. Bleeding from the brachiocephalic artery, pneumonia, thromboembolism of the pulmonary artery, and anastomotic leak were the causes of death. Op-Translated by Jerome Katsell, Ph.D.

Carinal resection and reconstruction in thoracic malignancies

“…Malignant tumors involving the carina and/or distal trachea without systemic or lymphatic metastases are uncommon but not rare . Most patients were diagnosed at an advanced stage, and were likely to be no longer candidates for surgical resection.…”

“…Malignant tumors involving the carina and/or distal trachea without lymphatic or systemic metastasis are uncommon but not rare . As these tumors are localized diseases, local management is an effective treatment with survival benefit.…”

Carinal resection and sleeve pneumonectomy

“…It is important not to mobilize distal trachea too extensive in order to preserve maximal blood supply. The trachea is transected above the carina and the left main bronchus near its origin (2). The distance of the resection line to the tumor should preferentially be 1 cm ( Figure 1A).…”

“…Neoplasms involving the carina and/or distal trachea without systemic or lymphatic metastases are uncommon but not rare (1,2). Most of these patients were diagnosed at an advanced stage, and were likely to be no longer candidates for surgical resection (1).…”

Surgical and combined correction of tracheal and laryngotracheal cicatricial stenosis and restenosis

“…С тех пор, как E. Küster в 1886 г. выполнил пер-вую циркулярную резекцию шейного отдела трахеи, а J. Mathey в 1951 г. -первую резекцию в грудном отделе, накоплен немалый опыт в хирургическом лечении при стенозах трахеи [4,[8][9][10][11], и теперь это вмешательство считается единственным радикаль-ным способом ликвидации ее рубцовой обструкции. Вместе с тем до настоящего времени многие пробле-мы этого раздела хирургии не решены, если учесть, что число послеоперационных осложнений коле-блется от 5,3 до 35,3%, а летальность -от 1,5 до 2,6% [4,12,13].…”