الفهرس 
INTRODUCTIONOnly 14 pages are availabe for public view
 |  | from | 76 |  |  |
| | | from | 76 | | |
Abstract
Tracheal stenosis is considered a potentially life-threatening condition. Tracheostomy and endotracheal intubation remain the commonest causes of benign tracheal stenosis. Postintubation tracheal stenosis is caused by regional ischemic necrosis of the tracheal wall. The lesions characteristically occur at the cuff and stomal site, presenting with symptoms and signs of airway obstruction. Surgical reconstruction is the gold standard in the management of benign tracheal stenosis. The use of metallic self- expandable stents to relieve airway obstruction in inoperable central airway lesions, especially in patients with medical co-morbidities was previously reported.
Tracheal neoplasms account for less than 1% of all malignancies. In spite of their low incidence, these tumors represent potentially lethal phenomena. In cases of airway compromise and unresectable disease, the airway may be maintained by repeated bronchoscopic debulkings, and the use of CO2 laser, silicone Montgomery T-tube and tracheal stents. The use of metallic expandable stents to relieve airway obstruction in advanced tracheal tumors was previously reported.
Our aim was to evaluate the use of metallic self- expandable tracheal stents in the management of airway obstruction secondary to different tracheal pathologies in patients who presented to the Otolaryngology Head and Neck Surgery at the Main Alexandria University Hospital, Egypt. The study was conducted as a retrospective group from January 2003 to November 2013 and a prospective group from December 2013 to December 2014. After endoscopic and radiological evaluation, expandable metallic tracheal stents (SENS; Ultraflex tracheal prosthesis; Boston Scientific Corp, Watertown, MA, USA) were inserted under general anesthesia to relieve airway obstruction.
Postoperative follow-up with regard to improvement of respiration, tolerability of the stent and reporting of complications was done. Thirty three patients were included in the study. Two groups were made, a benign group for patients with benign causes of tracheal stenosis and a malignant group were the cause was malignant cause either primary tracheal tumor or secondary tumor infiltrating and/or compressing the trachea.
Nineteen patients were in the benign group, ten males and nine females. All had been subjected to previous procedures before tracheal stenting e.g bronchoscopic dilatation
(19 patients), tracheoplasty (3 patients) and T-tube insertion (1 patient).The causes of tracheal stenting were being unfit for surgery (10 patients), long stenotic segment with intrathoracic segment (4 patients), failed surgery (3 patients) and tracheal stenosis at two levels (1 patient).Fourteen patients were in the malignant group, ten males and four females. Four patients (28.6%) had primary tracheal tumors and ten (71.4%) suffered from tumors infiltrating the trachea from nearby structures. The stent was easily inserted in all patients with no significant intraoperative complications. Postoperatively, the stents were well tolerated and all patients experienced good respiration. Complications occurred were obstructive granuloma which was statistically more significant in the benign group than malignant group, while intraoperative bleeding was statistically more in the malignant group than benign one. Other complications reported were transient cough, retention of secretions, migration of stent and bad odour. We concluded that Ultraflex self-expandable stent could be considered as a therapeutic option for inoperable central airway lesions, especially in patients with medical co-morbidities, as well as in cases of long stenotic segment with intrathoracic extension or failed surgery. Also Ultraflex metallic self-expandable stent is a good alternative for palliation of airway obstruction in cases of inoperable malignant tracheal tumors. Strict follow-up is mandatory for early detection and management of exp