ENDOSCOPIC TREATMENT OF POST-INTUBATION T RACHEAL STENOSIS - A REVIEWOF 58 CASES

Over a period of 6 years, 58 patients aged between 55+/-16 years have been treated for post-intubation tracheal stenosis (STPI). These patie nts were characterised by their frequency of an underlying respiratory or cardiac failure, a duration of intubation which was sometimes shor t and a delay between the extubation and the detection of stenosis Whi ch was less than one month in about one half of the cases. Thirty of t he 58 patients presented with respiratory distress on admission. All t he stenoses were treated initially by mechanical dilatation using a ri gid bronchoscope. Radial incisions using an Nd-Yag laser were performe d when necessary to facilitate the dilatation. The great majority of s tenoses which were not fitted up with a tracheal endoprosthesis (EPT) at the first attempt recurred leading to repeated therapeutic bronchos copies (221 sessions in all). Fitting an EPT (Dumon prosthesis) was ne cessary in 35 cases on 12 occasions at the first attempt with the firs t bronchoscopy, and 23 times following a recurrence. Amongst the recur ring stenoses a stabilisation was obtained at the price of repeated di latations (4.3 sessions on average in only nine patients). Seven patie nts finally had a surgical resection and anastamosis of the trachea, o f whom four had a transitory instillation of an EPT for the stenosis. The removal of the EPT was later attempted in 11 patients. Four did no t present with any symptomatic recurrence. The secondary migration of the EPT is in practice one of the main inconveniences of the silicon p rosthesis (8 cases now experienced). Our approach, which used to favou r the mechanical dilatation has lead to a relatively high number of fa ilures and thus to repeated bronchoscopies. This has lend us to re-def ine our therapeutic approach. The current schema which we propose is i n the course of being validated in which we use EPT and surgical repai r of the trachea more often. Only short stenoses (less than 1 cm) with a diaphragm are treated by dilatation and laser. The others are fitte d initially with an EPT. The final management is guided by the progres s in the stenosis, the tolerance of the endoprosthesis and the operabi lity of the patients.