Search

Your search keyword '"Rusakov MA"' showing total 19 results
Start Over Author "Rusakov MA" Topic trachea
19 results on '"Rusakov MA"'

1. [Assessment of tracheal elasticity and tracheal anastomosis tension in cicatricial stenosis].

Author

Parshin VD, Rusakov MA, Berikkhanov ZG, Simonova MS, and Ursov MA

Subjects
Adult, Cicatrix pathology, Cicatrix surgery, Constriction, Pathologic pathology, Constriction, Pathologic surgery, Endoscopy, Humans, Organ Size, Range of Motion, Articular, Anastomosis, Surgical adverse effects, Elasticity, Trachea pathology, Trachea surgery, Tracheal Stenosis diagnosis, Tracheal Stenosis etiology, Tracheal Stenosis surgery
Abstract

Objective: To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection., Material and Methods: At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively., Results: Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient., Conclusion: Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.

Published
2021
Full Text
View/download PDF

2. [Tracheolaryngeal resection for cicatricle stenosis].

Author

Parshin VD, Rusakov MA, Parshin VV, Titov VA, Parshin AV, and Starostin AV

Subjects
Female, Humans, Male, Middle Aged, Quality of Life, Recurrence, Russia, Tracheal Stenosis diagnosis, Tracheal Stenosis etiology, Treatment Outcome, Anastomosis, Surgical adverse effects, Anastomosis, Surgical methods, Cicatrix complications, Larynx surgery, Postoperative Complications diagnosis, Postoperative Complications etiology, Postoperative Complications psychology, Trachea surgery, Tracheal Stenosis surgery, Tracheotomy adverse effects, Tracheotomy methods
Abstract

Aim: To determine the safest and the most effective surgical treatment of patients with cicatricle stenosis of tracheolaryngeal segment via analysis of different approaches., Material and Methods: For the period 1963-2015 at Petrovsky Russian Research Center for Surgery and Sechenov First Moscow State Medical University 1128 patients with cicatricle tracheal stenosis have been treated. There were 683 men and 445 women. 684 (60.6%) patients were young and the most employable (21-50 years). All patients were divided into 2 groups depending on time of treatment: the first one included 297 patients between 1963 and 2000, the second group - 831 patients between 2001 and 2015. In group 1 tracheolaryngeal anastomosis was made in 10 (16.9%) out of 59 patients who underwent tracheal resection. Previously indication for this surgery was cicatricle stenosis of cervical trachea and larynx with upper borderline of cicatricle changes at least 2 cm from vocal folds. In group 2 these procedures were more frequent. 94 (28.5%) out of 330 patients underwent tracheolaryngeal resection. Cranial borderline of lesion was within 0.5 cm from the vocal folds (only if posterior laryngeal wall at the level of cricoid cartilage was intact). Difficult patients are those who need for double-level or redo repair and procedures with tracheostomy., Results: In the second group overall morbidity after tracheal resections followed by anastomosis was 5.6%. These complications were more common after tracheolaryngeal anastomosis (17%). There were no lethal outcomes after 94 tracheolaryngeal resections. Good long-term results were observed in 89.8% of patients after circular resection. Their quality of life was similar to that of healthy people. Preserved cicatricle tracheal segments during tracheal repair with T-shaped airway tube adversely affects quality of life in these patients in long-term period.

Published
2018
Full Text
View/download PDF

3. [Surgical approaches in surgery for cicatrical tracheal stenosis].

Author

Parshin VD, Rusakov MA, Parshin VV, Mirzoian OS, and Khoruzhenko AI

Subjects
Adolescent, Adult, Aged, Child, Cicatrix surgery, Female, Humans, Male, Middle Aged, Retrospective Studies, Trachea pathology, Tracheal Stenosis etiology, Treatment Outcome, Young Adult, Cicatrix complications, Sternotomy methods, Thoracotomy methods, Trachea surgery, Tracheal Stenosis surgery
Abstract

At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.

Published
2015
Full Text
View/download PDF

4. [Repeated tracheal resection for non-neoplastic restenosis].

Author

Parshin VD, Rusakov MA, Mirzoian OS, Parshin VV, Gorshkov KM, and Khoruzhenko AI

Subjects
Adult, Anastomosis, Surgical methods, Female, Follow-Up Studies, Humans, Male, Recurrence, Reoperation, Retrospective Studies, Young Adult, Postoperative Complications surgery, Thoracic Surgical Procedures methods, Trachea surgery, Tracheal Stenosis surgery
Abstract

Treatment of patients with recurrent cicatrical tracheal stenosis after previous circular tracheal resection is one of the most difficult problems in thoracic surgery at present time. In most cases repeated radical surgery as new resection is declined in favour of palliative treatment. It is often associated with lingering or perpetual preserving of T-shape or tracheostomy tube and respiratory tract stenting. Development of thoracic surgery last years permits to perform repeated tracheal resections with restoration of respiratory tract integrity by using of new tracheal anastomosis. For the last 4 years 6 such operations were performed with satisfactory immediate and remote results. Diagnostic algorithm before repeated surgery is similar to those before primary intervention. Special attention should be attended to state of remained parts of respiratory tract, degree and length of stenosis and tracheomalacia which may be result of divergence of edges of the primary anastomosis. Preserving of not less than 1/4 primary length of intact trachea with its satisfactory mobility is main condition for this surgery because it will permit to perform new anastomosis without high tension. Risk of postoperative complications after repeated operations is not higher than those after primary resection. But at present time these operations are in competence of small number of specialists and medical institutions with serious experience in thoracic surgery.

Published
2015
Full Text
View/download PDF

5. [Iatrogenic trachea and esophagus injury in intensive care practice: the surgeon's view"].

Author

Parshin VD, Vyzhigina MA, Eremenko AA, Nikoda VV, Rusakov MA, Vishnevskaia GA, and Parshin VV

Subjects
Adolescent, Adult, Aged, Child, Child, Preschool, Critical Care statistics & numerical data, Humans, Middle Aged, Tracheal Stenosis epidemiology, Tracheal Stenosis etiology, Tracheal Stenosis surgery, Tracheoesophageal Fistula epidemiology, Tracheoesophageal Fistula etiology, Tracheoesophageal Fistula surgery, Young Adult, Critical Care methods, Esophagus injuries, Esophagus surgery, Iatrogenic Disease prevention & control, Intubation adverse effects, Trachea injuries, Trachea surgery
Abstract

From 1963 to 2011 in the Department of lung and mediastinum surgery were treated 879 patients with trachea stenosis and 107 patients with benign tracheoesopageal fistula were treated in the Department of lung and mediastinum surgery from 1963 to 2011. latrogenic trachea and the esophagus damage was caused by long-term ALV in 87% of cases. Patients were aged from 5 to 79 years. 47.2% of patients came with functioning tracheostome. 25.7% of patients had a clinically significant respiratory disorder at admission, 10.2 % of which were life-threatening. Iatrogenic damage of the trachea was identified before extubation or decannulation only in 27% of patients. In such circumstances, prevention and diagnostics of iatrogenic injuries, as well as initial care alternatives takes on special significance.

Published
2013

6. [Two-level resection of the trachea with anastomoses in multifocal cicatricial stenosis].

Author

Parshin VD, Rusakov MA, Titov VA, Nikoda VV, and Khetagurov MA

Subjects
Anastomosis, Surgical methods, Cicatrix diagnosis, Cicatrix surgery, Female, Follow-Up Studies, Humans, Tomography, X-Ray Computed, Tracheal Stenosis diagnosis, Tracheal Stenosis etiology, Young Adult, Cicatrix complications, Trachea surgery, Tracheal Stenosis surgery, Tracheostomy adverse effects
Published
2012

8. [Closed tracheal injury--surgical or anesthesiologic-and-resuscitative problem].

Author

Parshin VD, Vyzhigina MA, Rusakov MA, Zhukova SG, Riabova OS, Titov VA, and Pogodina AN

Subjects
Adult, Humans, Male, Rupture, Trachea surgery, Treatment Outcome, Anesthesia methods, Resuscitation methods, Thoracic Injuries surgery, Thoracic Surgical Procedures methods, Trachea injuries, Wounds, Nonpenetrating surgery
Abstract

Closed chest injury with rupture of the trachea and main bronchi is a rare and extremely life-threatening pathology. In suspected tracheal injury, as well as in severe closed chest injury with the gas syndrome, diagnostic tracheobronchoscopy with possible intubation is indicated in order to isolate the airway lumen from the paratracheal space. Tracheal intubation through a fibrobronchoscope should be considered to be the first aid. Tracheostomy is not the operation of choice and it is indicated only when there is no available technology or experience in intubating the airways under endoscopic guidance. Most small tracheal ruptures in closed chest injury, as well as those of iatrogenic postintubational genesis, may be medically eliminated. A surgeon jointly with an anesthetist and a bronchological endoscopist should determine indications for the operation. The operation should be performed as early as possible. It should be started from the intubation of the airways and the insertion of the end of an intubational tube caudally the rupture. When the breathing circuit is depressurized, all alternative gas exchange maintenance techniques available at an anesthetist's disposal, including high-frequency artificial ventilation and a shunt-breathing system, are indicated, which should provide a patient's safety and surgical comfort.

Published
2007

9. [Iatrogenic postintubation tracheal rupture].

Author

Parshin VD, Pogodina AN, Vyzhigina MA, and Rusakov MA

Subjects
Adult, Aged, Female, Humans, Male, Middle Aged, Radiography, Rupture diagnostic imaging, Rupture etiology, Rupture pathology, Rupture surgery, Trachea diagnostic imaging, Trachea pathology, Trachea surgery, Treatment Outcome, Intubation, Intratracheal adverse effects, Trachea injuries
Abstract

Iatrogenic damage to the trachea in its intubation and during artificial lung ventilation ,is a rare, severe and commonly fatal complication in resuscitative care. The risk for tracheal damage increases in emergency, time shortage and hypoxia in a patient, while intubating with a double-lumen tube, using rigid mandrin guides without a safety limit stop, and having difficulties in intubating the patient due to his/her anatomic features. Fibrotracheoscopy is the principal diagnostic techniques that may cause tracheal rupture, which may be transformed to a therapeutic measure, by placing an intubation tube caudally at the site of tracheal rupture. Among 33 patients, only 6 underwent surgical defect suturing. When the trachea is ruptured, surgery is indicated for respiratory hemorrhage unstopped by inflating the cuff of an intubation tube and, perhaps, associated with the damage to a large vessel; for progressive gas syndrome, extensive rupture of the membranous part with the involvement of the tracheal bifurcation and main bronchus or with the interposition of paratracheal tissues; for a concomitant damage to the esophagus; for rupture of the tracheal membranous part during intubation before thoracotomy or for rupture detected during thoracotomy for another cause. Correct and timely care may eliminate this life-threatening iatrogenic complication, by yielding a good effect.

Published
2006

10. [Intubation tube-induced tracheal ruptures].

Author

Perel'man MI, Parshin VD, Gudovskiĭ LM, and Rusakov MA

Subjects
Adult, Aged, Bronchoscopy, Diagnosis, Differential, Female, Fiber Optic Technology, Humans, Intubation, Intratracheal instrumentation, Male, Middle Aged, Retrospective Studies, Rupture, Suture Techniques, Wounds, Penetrating diagnosis, Wounds, Penetrating surgery, Intubation, Intratracheal adverse effects, Trachea injuries, Wounds, Penetrating etiology
Published
2005

11. [Endoprosthesis of the trachea in the treatment of cicatricial stenosis with tracheomalacia].

Author

Biriukov IuV, Rabkin Ikh, Kurmaev ShM, Samokhin AIa, and Rusakov MA

Subjects
Adult, Cartilage Diseases etiology, Cicatrix complications, Female, Humans, Male, Middle Aged, Trachea injuries, Tracheal Stenosis etiology, Alloys, Cartilage Diseases surgery, Intubation, Intratracheal adverse effects, Prostheses and Implants, Trachea surgery, Tracheal Stenosis surgery, Tracheostomy adverse effects
Abstract

The authors discuss the results of the first experience in the clinical use of nitinol spiral endoprostheses as an artificial supporting framework of the trachea in local destruction of the tracheal cartilages and loss of rigidity of the tracheal wall. Tracheal endoprosthetics was carried out in 6 patients with cicatrical stenoses and tracheomalacia. The causes of possible complications (growth of granulation tissue into the tracheal lumen and displacement of the endoprosthesis) are analysed and the means of their prevention are suggested. It was established that the nithinol spiral endoprosthesis may be covered by epithelialized tracheal mucosa and provide an adequate rigid lumen for the tracheal area devoid of the framework. The diameter of the implanted prosthesis must be 2-3 mm larger than the diameter of the normal tracheal lumen. Temporary introduction of a protector tube into the repaired trachea may shorten the duration of treatment significantly.

Published
1990

12. [Cryosurgery of trachea and bronchi (literature review)].

Author

Rusakov MA

Subjects
Animals, Bronchi pathology, Bronchial Neoplasms surgery, Dogs, Guinea Pigs, Humans, Neoplasms, Experimental surgery, Rats, Trachea pathology, Tracheal Neoplasms surgery, Bronchi surgery, Cryosurgery, Trachea surgery
Published
1981

13. [Endoscopic laser surgery of the trachea and bronchi].

Author

Rusakov MA and Biriukov IuV

Subjects
Adolescent, Adult, Aged, Bronchial Neoplasms surgery, Bronchoscopy, Child, Evaluation Studies as Topic, Female, Humans, Laser Therapy instrumentation, Male, Middle Aged, Tracheal Neoplasms surgery, Tracheal Stenosis surgery, Bronchi surgery, Laser Therapy methods, Trachea surgery
Abstract

The authors conducted 76 endoscopic laser operations on 51 patients with malignant (18) and benign (9) tumors and cicatricial stenosis (24) of the trachea and bronchi. An AYG laser (on and yttrium aluminium garnet with neodymium) with a power of up to 27.5 Wt was used as the source of laser radiation. Intraoperative complications were recorded in 2 (2.6%) cases. The immediate results were good in 88.2%, satisfactory in 3.9%, and poor in 5.9% of patients. It is concluded that the endoscopic use of the AYG laser for the destruction of tumors, cicatrices, and granulations in the tracheal and bronchial lumen both as the first stage of surgical treatment and as an independent palliative method in inoperable patients is highly effective and safe.

Published
1989

15. [Surgery for carcinoid tumor of lungs, bronchi and trachea]

Author

I D Zulufova, Vladimir Parshin, Rusakov Ma, and A V Parshin

Subjects
Adult, Male, medicine.medical_specialty, Carcinoid tumors, Mediastinal tumor, Bronchi, Carcinoid Tumor, Lesion, Young Adult, Tracheal Neoplasm, Medicine, Humans, In patient, Pneumonectomy, Lung, Aged, Aged, 80 and over, Surgical approach, business.industry, Disease progression, Bronchial Neoplasms, General Medicine, Middle Aged, medicine.disease, Surgery, Trachea, Female, medicine.symptom, Neoplasm Recurrence, Local, business, Lung tissue
Abstract

To analyze the long-term outcomes of local resections in patients with carcinoid tumors of bronchopulmonary system.There were 52 patients with tracheal and bronchopulmonary carcinoid for the period 2013-2019. The sample included 21 men and 31 women. Age of patients ranged from 20 to 82 years (mean 62 years). Typical carcinoid was diagnosed in 34 cases, atypical carcinoid - in 18 cases. Central tumor was diagnosed in 26 patients. Tracheal neoplasm was found in 2 patients. Another patient had mediastinal tumor. Five patients underwent resection with broncho- or tracheobronchoplastic reconstruction.Surgical approach for carcinoid is determined by its differentiation, localization and lung tissue lesion following a long-standing tumor. These operations are quite safe. Complications occurred after 4 (7.7%) surgeries. Long-term results were followed-up for the period from 8 months to 7 years. There were no signs of recurrence and disease progression after organ-sparing bronchial resection. Local resection with bronchoplasty is advisable for typical carcinoid.Карциноидные опухоли бронхолегочной системы относительно редкие новообразования легких. По последним классификациям их относят к злокачественным опухолям, при которых показана легочная резекция. Эндоскопическое внутрипросветное лечение сопряжено с высоким риском локального рецидива, и показания к нему должны быть наиболее строгими. Альтернативой является резекция бронха с бронхопластической реконструкцией. При периферической локализацией карциноида возможна сублобарная резекция. Оправданность этих операций требует своего подтверждения на основании изучения отдаленных результатов.В отделении торакальной хирургии клиники факультетской хирургии Сеченовского университета с 2013 по 2019 г. пролечено 52 пациента с трахеобронхолегочным карциноидом, среди них 21 мужчина и 31 женщина. Возраст больных от 20 до 82 лет, в среднем 62 года. Типичный карциноид диагностировали у 34 больных, атипичный — у 18, центральное расположение опухоли — у 26. В трахее опухоль располагалась у 2 пациентов. Еще у одного пациента периферическая опухоль имела медиастинальную форму и большей своей частью располагалась в средостении. У 5 пациентов выполнена резекция с бронхо- или трахеобронхопластической реконструкцией.Вариант операции при карциноиде определяется степенью его дифференцировки, локализацией и развившимися осложнениями в легочной ткани при длительно существующей опухоли. Эти операции достаточно безопасны. Осложнения диагностировали после 4 (7,7%) операций. Отдаленные результаты прослежены в сроки от 8 мес до 7 лет. Признаков рецидива, прогрессирования заболевания в группе пациентов с изолированной резекцией бронха с сохранением всего органа не отмечено. При типичном карциноиде оправдана локальная резекция с бронхопластикой.

Published
2021

16. [Assessment of tracheal elasticity and tracheal anastomosis tension in cicatricial stenosis]

Author

Z G Berikkhanov, Rusakov Ma, M A Ursov, Vladimir Parshin, and M S Simonova

Subjects
Adult, medicine.medical_specialty, Constriction, Pathologic, 030204 cardiovascular system & hematology, Anastomosis, Tracheal resection, 03 medical and health sciences, Cicatrix, 0302 clinical medicine, Medicine, Humans, In patient, Elasticity (economics), Range of Motion, Articular, business.industry, Tension (physics), Anastomosis, Surgical, Endoscopy, General Medicine, Organ Size, respiratory system, Elasticity, Tracheal Stenosis, Surgery, Trachea, 030228 respiratory system, Cicatricial stenosis, Head position, business
Abstract

To assess the tracheal elasticity and tracheal anastomosis tension for prevention of anastomosis-related complications and estimation of the maximum length of resection.At the first stage, 20 patients with cicatricial tracheal stenosis underwent tracheoscopy in usual position, under maximum flexion and extension of the head for the period from September 2017 to December 2019. We measured the total length of trachea and length of stenotic segment. Tracheal extensibility was assessed considering the difference in measurements. At the second stage, anastomosis tension was intraoperatively measured using a dynamometer in normal head position, as well as at maximum flexion in 22 patients who underwent tracheal resection. Unlike multiple other studies, we studied tissue tension intraoperatively.Mean length of trachea was 12.8 cm, extensibility - 1.3 cm. Tracheal elasticity was greater in patients with a longer trachea and in patients under 40 years old. Mean length of resection was 3.9 cm (30% of mean length of trachea), anastomosis tension - 2.7 H or 270 g. Head flexion was followed by tension decrease by 0.7 H (26.9%), i.e. 70 g. This approach is less effective in case of resection of more than 30% of trachea length in a particular patient.Further experience in measurement of tracheal extensibility and anastomosis tension will make it possible to establish clinical significance of these indicators for prevention of complications.Оценить эластичность трахеи и измерить натяжение тканей на анастомозе трахеи с целью профилактики осложнений со стороны трахеального анастомоза и определения максимальной протяженности резекции.С сентября 2017 по декабрь 2019 г. в Сеченовском университете на первом этапе исследования 20 пациентам с подтвержденным диагнозом рубцового стеноза трахеи выполнена фибротрахеоскопия в обычном положении, в положении максимального сгибания и разгибания головы. При этом измеряли общую длину трахеи у конкретного пациента и протяженность стенозированного участка. О степени растяжимости трахеи косвенно судили по разнице результатов измерения. На втором этапе 22 пациентам, которым выполнили резекцию трахеи, во время операции исследовали силу натяжения тканей на анастомозе при помощи динамометра сжатия—растяжения в обычном положении головы, а также при максимальном сгибании. В отличие от многих других исследований мы изучали степень натяжения тканей во время операции, при жизни больного.Длина трахеи в среднем составила 12,8 см, ее растяжимость составила 1,3 см. Эластичность трахеи больше у пациентов с более длинной трахеей и у пациентов моложе 40 лет. Средняя протяженность резекции составмла 3,9 см (30% средней длины трахеи), натяжение на анастомозе — 2,7 Н, или 270 г. При приведении головы к передней грудной стенке натяжение на анастомозе в среднем уменьшалось на 0,7 Н (на 26,9%), т.е. на 70 г. При резекции более 30% длины трахеи конкретного пациента эффективность такого приема снижается.Накопление опыта по определению растяжимости трахеи и степени натяжения тканей на анастомозе в дальнейшем позволит установить клиническую значимость этих показателей для профилактики осложнений трахеального анастомоза.

Published
2021

17. [Tracheal resection after prolonged stenting in surgery for cicatricial stenosis]

Author

D M Amangeldiev, Parshin Vv, A V Parshin, Rusakov Ma, R Yu Mayer, and Vladimir Parshin

Subjects
medicine.medical_specialty, medicine.medical_treatment, Constriction, Pathologic, 030204 cardiovascular system & hematology, Anastomosis, 03 medical and health sciences, 0302 clinical medicine, Tracheostomy, Restenosis, medicine, Humans, Radical surgery, Retrospective Studies, business.industry, Mortality rate, Stent, General Medicine, medicine.disease, Surgery, Tracheal Stenosis, Trachea, 030228 respiratory system, Concomitant, Stents, Complication, business
Abstract

To analyze early and delayed results of various variants of circular tracheal resection (CTR) with anastomosis, to determine the safest approach, dates and conditions of correction, features of postoperative period in patients after previous tracheal surgery.There were 831 patients with cicatricial tracheal stenosis. CTR was made in 330 (39.7%) patients. Most patients had previous prolonged ICU-stay. The patients were divided into 4 groups. Group 1 consisted of 61 (18.5%) patients after previous prolonged tracheal stenting. Group 2 included 45 (13.6%) patients who underwent circular tracheal resection with a functioning tracheostomy. Tracheostomy tube served as a stent in these patients. Group 3 enrolled 32 (9.7%) patients with previous staged reconstructive plastic surgeries on cranial segment of the respiratory tract. Tracheostomy or stent were absent in 192 (58.2%) patients who underwent circular tracheal resection at the first hospitalization. These patients were enrolled into the fourth (control) group. Favorable outcomes (without complications and mortality) were achieved in 85.5% (n=282) of patients. Postoperative complications occurred in 48 (14.5%) patients. Mortality rate was 0.6% (n=2). The greatest number of complications including anastomositis and restenosis was noted in patients after CTR and previous tracheoplasty with T-tube (n=8, 25%). The most common complication in patients after tracheal resection and previous stenting was anastomositis (14.7%). Long-term results depended on postoperative complications and methods of their correction. Recurrent stenosis occurred in 5 (1.5%) patients within the period of 3 months - 8 years. CTR after previous tracheoplasty with T-tube was carried out in 4 of these patients.Tracheal resection after preliminary stenting or tracheostomy is quite safe and technically feasible. Stenting allows postponing radical surgery for correction of concomitant diseases and closure of tracheostomy as a focus of infection within the surgical approach and further tracheal anastomosis. Tracheal resection with simultaneous closure of tracheostomy results a higher rate of postoperative complications compared with preliminary stenting.Цель исследования - на основании изучения ближайших и отделенных результатов лечения определить наиболее безопасный вариант циркулярной резекции трахеи (ЦРТ) с анастомозом, сроки и условия ее выполнения, а также особенности послеоперационного периода у пациентов после предшествующих операций на трахее. Материал и методы. По поводу рубцового стеноза трахеи пролечен 831 больной, в том числе у 330 (39,7%) пациентов выполнена ЦРТ. У большинства больных был постреанимационный этиопатогенез заболевания. Пациенты разделены на четыре группы. К 1-й отнесены 61 (18,5%) больной, оперированный после предварительного длительного стентирования трахеи, ко 2-й группе - 45 (13,6%) пациентов, перенесших ЦРТ с функционирующей трахеостомой, где трахеостомическая трубка выполняла роль стента. В 3-ю группу вошли 32 (9,7%) больных, которые до резекции перенесли этапные реконструктивно-пластические операции по формированию краниального отдела дыхательного пути. Трахеостомы или стенты были у 192 (58,2%) пациентов. Им произвели ЦРТ при первой госпитализации (4-я, контрольная, группа). Хорошие результаты (без осложнений и летальных исходов) достигнуты у 282 (85,5%) пациентов. Осложнения в послеоперационном периоде отмечены у 48 (14,5%) больных. Умерли 2 (0,6%,) больных. Наибольшее число осложнений, среди которых преобладали анастомозит и рестеноз, установлено у 8 (25%) пациентов с ЦРТ после предшествующих трахеопластических операций с Т-трубкой. Чаще всего после резекции трахеи в группе пациентов с предварительным стентированием наблюдали анастомозит - 14,7% больных. Отдаленные результаты зависели от послеоперационных осложнений и способов их купирования. В сроки от 3 мес до 8 лет рестеноз возник у 5 (1,5%) пациентов, среди которых 4 перенесли ЦРТ после предшествующей трахеопластики с Т-трубкой. Выводы. Резекция трахеи после предварительного стентирования или трахеостомы достаточно безопасна и технически выполнима. Стентирование позволяет отсрочить окончательную радикальную операцию на период реабилитации по поводу конкурирующих заболеваний, а также устранить трахеостому как очаг инфекции в зоне хирургического доступа и трахеальной стенки, подлежащей анастомозированию. Для резекции трахеи с удалением трахеостомы, одномоментным и после предшествующих операций на трахее, характерна более высокая частота послеоперационных осложнений.

Published
2019

18. [Staged surgical treatment of subtotal tracheal cicatrical stenosis as an alternative to transplantation]

Author

Parshin Vv, A G Vasiukevich, M M Gudkov, Rusakov Ma, and Vladimir Parshin

Subjects
medicine.medical_specialty, business.industry, medicine.medical_treatment, MEDLINE, Stent, General Medicine, Constriction, Pathologic, 030204 cardiovascular system & hematology, medicine.disease, Surgery, Constriction, Tracheal Stenosis, Transplantation, Trachea, 03 medical and health sciences, Stenosis, Cicatrix, 0302 clinical medicine, 030220 oncology & carcinogenesis, medicine, Humans, business, Surgical treatment
Published
2016

19. Surgical approaches in surgery for cicatrical tracheal stenosis

Author

Khoruzhenko Ai, Vladimir Parshin, Parshin Vv, Mirzoian Os, and Rusakov Ma

Subjects
Adult, Male, medicine.medical_specialty, Adolescent, medicine.medical_treatment, Cicatrix, Young Adult, Humans, Medicine, Thoracotomy, Child, Primary bronchus, Aged, Retrospective Studies, Rib cage, Surgical approach, business.industry, Operating team, General Medicine, Middle Aged, respiratory system, medicine.disease, Sternotomy, Tracheal Stenosis, Surgery, Trachea, Stenosis, Treatment Outcome, Membranous wall, Female, Radiology, business
Abstract

At present time several surgical approaches are being used for cicatrical tracheal stenosis including cervicotomy, longitudinal- circumferential sternotomy and thoracotomy. Besides location of stenosis an approach is being determined by constitutional and anatomical features of patient, surgeon's and anesthesiologist's experience, well-coordinated work of operating team. If pathological process is placed in cervico-laryngeal, cervical and upper thoracic segment cervicotomy is preferable. Partial longitudinal-circumferential sternotomy is believed to be adequate in case of lesion of thoracic trachea and its bifurcation. This approach provides all types of tracheal reconstructions. Technical difficulties appear if process is localized in membranous wall of suprabifurcational part, bifurcation and primary bronchus. In these cases we recommend thoracotomy through the bed of resected the 3rd or the 4th ribs and patient's position on his front. Interventions including pulmonary tissue resection and tracheal edges convergence are possible through thoracotomy.Одним из основополагающих принципов в трахеальной хирургии является правильный выбор операционного доступа. Игнорирование его важности может привести к фатальным событиям, когда хирургу сложно существенно повлиять на дальнейшее развитие событий. С 1963 г. по декабрь 2012 г. были пролечены 867 больных с рубцовым стенозом трахеи. В настоящее время в хирургии рубцового стеноза трахеи (РСТ) используют несколько операционных доступов - цервикотомию (45,8%), продольно-поперечную стернотомию (28,8%), реже торакотомию - у 21 больного. Причем у 14 из них этот подход осуществили в положении пациента на животе, а у 12 - в сочетании с предварительной мобилизацией трахеи через цервикотомный доступ. В определении оптимального хирургического подхода присутствует достаточно большая доля врачебного искусства наряду с научными знаниями и хирургическим умением. При локализации патологического процесса в шейногортанном сегменте, шейном и верхнегрудном отделах доступом выбора следует считать цервикотомию. При расположении процесса в грудном отделе трахеи и ее бифуркации универсальным доступом можно считать частичную продольно-поперечную стернотомию, которая позволяет выполнить все варианты трахеальной реконструкции. Технические сложности возникают при локализации процесса в области мембранозной стенки надбифуркационного отдела, бифуркации и главных бронхов. В этих случаях мы рекомендуем торакотомию, предпочтительнее в положении больного на животе и по ложу резервированного III или IV ребра. Через торакотомию возможно выполнение операций, связанных с резекцией легочной ткани, позволяющих в конечном итоге сблизить концы сшиваемой трахеи.

Published
2015
Full Text
View/download PDF

Catalog

Books, media, physical & digital resources
See catalog results