Search

The experience of treatment of 118 patients with non-neoplastic tracheoesophageal fistulas is presented in the article. Radical surgeries was performed in 85.6% cases, palliative operations - in 4.2% of patients. Conservative therapy was rare (12 patients). The volume of radical interventions was different. There was volume increase in case of concomitant tracheal stenosis or involvement in process adjacent organs and tissues. It is frequent situation last years. Surgical stapling instruments were used in 62 patients during surgery. Domestic (UKS-20, UKS-30, UO-40, UO-60) and import instruments were applied. Postoperative complications were diagnosed in 32.7% of patients. The most complications were determined with exacerbation of inflammation in lungs (exacerbation of purulent bronchitis, pneumonia, etc.). It was not revealed complications determined with surgical stapling instruments using for tracheal or esophageal defects removal in any patients. Relapse in long-term period was observed in 10 radically operated patients. All of them underwent tracheoplastic surgeries on the cervical and thoracic trachea except tracheoesophageal fistula separation. Clearance of the respiratory tract was formed by using of T-tube in the future. Surgical stapling instrument was used only in 2 of these patients during radical surgery. 7 patients were re-operated for tracheoesophageal fistula relapse with good result.

Unlabelled: The problem of respiratory support in tracheal surgery is still discussed in recent days. Anaesthesiologist must choose the most effective and safe respiratory technique during tracheal resection and reconstruction. The article deals with a case of comparison of apneic oxygenation (AO) and high frequency jet ventilation (HFJV) during double level tracheal resection and reconstruction in patient with multifocal tracheal stenosis and underlying cerebral trauma., Materials and Methods: AO and HFJV were used due to surgical need for 20 min each technique. PvO2, PvCO2, hematocrit, blood glucose, acid-base balance in the v. Jugularis interna, noninvasive arterial pressure, heart rate, ECG and body temperature were fixed before and after the changing of respiratory support type. Additionally peak systolic speed (S) of blood flow in the a. Cerebralis media sinister was fixed by transcranial Doppler ("Angiodin BIOSS", Russia)., Results: Oxygenation of venous blood was sufficient after the both HFJV and AO use; PvO2 was 67.6 and 74.3 torr respectively. Speed of PvCO2 increasing was higher during AO (1.46 torr per min) than during HFJV (0.73 torr per min). Increase of S was bigger during AO than HFJV as well (59 vs 37%). The changes of PvCO2 and S were normalized in 15 min after reconnection to conventional mechanical ventilation. Other fixed parameters were normal and same during the use of both respiratory techniques. The patient involved in the study did not have any neurological or surgical complications in early postoperative period., Conclusions: Both studied respiratory techniques provide sufficient blood oxygenation and can be accompanied with hypercapnia and cerebral hyperemia. These observations evident about the necessity to study the role of hyperoxia, hypercapnia and cerebral hyperemia in patients with underlying cerebral trauma undergoing tracheal resection and reconstruction. The study will help to make a strategy of the foreground use of HFJV and AO in these patients.

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.

The article summarizes the experience of treatment of 107 patients with tracheoesophageal fistula of nonneoplastic etiology. Etiology, diagnostic and treatment approaches were analyzed and compared, depending on the time period. The proportion of patients with combined pathology as tracheoesophageal fistula and cicatrical stenosis of the trachea has significantly increased recently. The main cause of fistulation was the jatrogenic tracheal injury during the mechanical lung ventilation. Basic diagnostic methods were endoscopy and computed tomography. The main objective of emergency remains isolation of the tracheobronchial tree from the gastrointestinal tract. Radical surgery can cure 97.8% of patients with minimal risk, including comorbidity. Conservative treatment and palliative surgery should be used only in case of the curative treatment failure or on the preparatory stage.

The results of the microbiological diagnosis of infective inflammatory complications in patients with iatrogenic esophageotracheal fistula and the tactics of their antibacterial prophylaxis and therapy within a 9-year observation period (2003-2011) were analysed. The main organisms colonizing the tracheobronchial tree in the patients were S. epidermidis, S. aureus, enteric bacteria, P. aeruginosa and Candida. An increase of the S. epidermidis resistance to rifampicin, moxifloxacin and especially ciprofloxacin was observed. The resistance of S. aureus did not significantly change. Within the observation period, high susceptibility of all the Staphylococcus isolates to vancomycin and linezolid remained stable. Among the nonfermenting gramnegative bacteria, the P. aeruginosa isolates were the most frequent and characterized by a lower portion of the isolates with preserved susceptibility to the agents (except polymyxin B) known earlier as antipyocyanic antibiotics, i.e. to imipenem and cefepim. Since the proportion of P. aeruginosa in the etiology of pyoinflammatory processes in the region of esophageotracheal fistula ranged within 9.3 to 17.5%, the fact should be considered in the antibiotic therapy. There was observed an increase in the frequency of infectious complications due to other nonfermenting gramnegative bacteria (acinetobacters) and first of all A.baumannii. Various Candida isolates were characterized by dependence of the susceptibility on the selective pressure of irrational therapy, as well as their species (the presence of such species as C. Krusei and C. glabrata with natural resistance), that required not only the species identification but also determination of the Candida isolates resistance in every particular case.

759 patients with cucatritial stenosis of trachea were treated in the Russian Scientific Center of Surgery in the period from 1963 to 2009. Extensive or multifocal stenosis was diagnosed in 172 patients. 157 patients were previously operated in other hospitals. The lesion of larynx during admission was diagnosed in 122 cases. All patients were operated in compliance with the principle of alternation methods of anesthesia and respiratory support. As a result of consistent application of the landmark reconstructive-plastic operations and resection in combination with endoscopic surgery good results were achieved. Based on the data, treatment algorithm of extended and multifocal cicatricial stenosis of the trachea was developed.

One of the crucial features of the reconstructive surgery of the trachea is the choice of suturing method and materials. The authors' experience of tracheal stenoses treatment counts 759 patients, aged from 9 to 77 years. The number of administered patients, who had been operated earlier in other hospitals, has drastically increased recently. The amount of patients with long tracheal stenoses has also increased. The novel operative techniques of tracheal suture, suggested by the authors, permit better results of rehabilitation.

Methods for microbiological monitoring could analyze the microflora isolated in 372 patients with iatrogenic diseases of the trachea and esophagus, who were treated at the Department for Surgery of the Lung and Mediastinum, Acad. B. V. Petrovsky Russian Research Center of Surgery, Russian Academy of Medical Sciences, in 2003 to 2009. Major groups of microorganisms colonizing the tracheobronchial tree in patients who had undergone long-term resuscitation, injuries, surgery, etc. and in those who had admitted to the department from other clinics are identified. The main clinically significant microorganisms isolated during the pathological process in this area were Staphylococcus epidermadis (3.9-13.3%), St. aureus (12.4-21.1%), Pseudomonas eruginosa (9.2-17.5%), and Candida fungi (7.8-12.2%). This indicates the greater importance of the fungal microflora and its representatives' resistance to the most commonly used drugs. Rational antibacterial therapy regimens are proposed in relation to the type of microorganisms colonizing the tracheobronchial tree.

Microbiologic analysis of tracheal and gastrostomic discharge was performed in 327 patients with iatrogenic injuries of trachea and esophagus, operated during 2003-2008. Main groups of microorganisms, colonizing the tracheobronchial tree were defined. St. epidermalis was defined in 3.9-13.3%, St. aureus - in 12.4-21.1%, Ps. small a. Cyrilliceruginosa - in 9.2-17.5% of cases. Increase of Candidae colonization was revealed (7.8-12.2%). The increase of polyresistant strains identification was typical. St. epidermalis and St. aureus demonstrated the preserving high sensitivity to vankomycin and linesolide, whereas Ps. aeruginosa showed the growth of resistance to all groups of antibiotics, but polymyxin. The common decrease of antibiotic activity requires the realization of complex antibacterial and antimycotic treatment.

The paper analyzes the etiology and pathogenesis of respiratory organ fistulas and their prevention and various treatment options (radical and palliative surgery and medical therapy). Particular attention is given to tracheoesophageal fistulas that are iatrogenic complications in anesthetic and intensive cares. The experience in treating the patients at the Department of Thoracic Surgery, Russian Research Center of Surgery, Russian Academy of Medical Sciences, before 1991 and from 1992 to 2007 is analyzed. Today's approach to the etiology and therapy for this severe iatrogenic complication is determined by the development of measures to prevent this complication and by the change in treatment policy in favor of early radical surgical interventions.

4023 operations on account of primary bronchopulmonary cancer were performed in the period of 1963--2006 years. Rare malignant tumors (carcinoid, adenocystic cancer, sarcoma, large cell carcinoma etc.) were diagnosed in 379 (9,1%) cases. 275 patients of those had bronchpulmonary carcinoid; adenocystic cancer was diagnosed in 26 patients; 67 had various types of non-epithelial malignant tumors and 11 had a large cell carcinoma. All patients were operated on, morphological verification was obtained in all cases. The surgical tactics in patients with rare malignant tumours should be the same as for non-small cell lung--lobectomy of pneumonectomy with lyphadenectomy. The long term follow-up results witness the advisability of surgical treatment.

Overall 553 patients aged 9 to 77 years with cicatrical stenoses of trachea were treated. The causes of stenoses were tracheostomy (345 patients), intubation of trachea (155), trauma (29), unknown (24). Surgical methods of treatment were used at 448 (81.0%) patients, endoscopic methods--at 105 (19.0%); overall 1184 operations have been performed. Transplantation of donor thyrotracheal complex has been performed at 1 patient with subtotal cicatrical stenosis of trachea. Combination of staged reconstructive and plastic operations with endoscopic procedures permits to achieve good functional results. Treatment of these patients should be performed at special medical centers which have all the necessary technologies.

Among 4005 patients with lung cancer 26 (0.65%) of them had adenocystic bronchial cancer, including 13 male and 13 female patients aged 13 to 60 years. Overall 33 operations have been performed at 26 patients, 5 of them were operated twice, and 1 patient underwent 3 surgical procedures. The plastic operations on bronchi (10) were the main surgical procedures. Four patients underwent pneumonectomy with resection of tracheal bifurcation, and 2 patients - circular resection of primary bronchus with resection of carine and tracheobronchial angle. One patient died after surgery, postoperative complications were seen at 4 patients including hemothorax (1), bleeding (1) and empyema (2). Twenty-five patients have been discharged, 21 of them were followed-up. Three patients survived more 3 years, 6 patients - more 5 years, 8 - more 10 years, 2 - more 15 years, and 2 - more 20 years. Long-term results of radical surgical treatment argue the efficacy of these surgeries at adenocystic bronchial cancer.