[Surgical endoscopy of the airways].
METHODS
Between April 1993 and April 1996, 146 endoscopic procedures were performed in 128 patients (144 with Nd:YAG laser) with benign or malignant obstructions of the airway. Removal of foreign bodies are not included in this series. Twenty resections were performed with the flexible fiberoptic bronchoscope under local anesthesia and 126 with the rigid tube under general anesthesia. Power settings were always between 20 and 35 Watts. Eighteen procedures were performed in emergency. Fifteen patients had a benign postintubation tracheal stricture (20 treatments-11 Dumon stents and 1 Montgomery tube). Eighty-two patients (90 treatments-12 stents) had malignant lesions of the airways (trachea 11, carina 2, RMB 22, LMB 27, TI 11, LULB 3, RULB 2, LILB 4). Laryngeal, tracheal or bronchial granulations were present in 19 patients (21 treatments). Other lesions were present in 11 patients (14 treatments-6 stents).


RESULTS
Major complications occurring during laser resections were bleeding (2), hypoxia (1) and cardiac arrhythmia (2); 2 patients died 24 hours after the procedure for cardio-respiratory failure. The airway calibre was improved in 100% of patients with benign lesions and 82.4% of patients with malignancy. In the latter group the trachea, main stem bronchi and truncus intermedius calibre was improved better than the lobar bronchi. All patients with malignancy underwent chemo-radiotherapy without respiratory distress.


CONCLUSIONS
Nd:YAG laser therapy is a safe and effective mean of releasing airway obstructions; indwelling stents contribute to further improve the results.
Cattedra di Chirurgia Toracica, Università degli Studi di Roma La Sapienza.
F
F
Venuta
T
T
De Giacomo
E A
EA
Rendina
G
G
Della Rocca
I
I
Flaishman
A M
AM
Ciccone
L
L
Pompei
C
C
Ricci
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001980:Bronchi / Q000601:surgery*; D001984:Bronchial Neoplasms / Q000601:surgery; D001999:Bronchoscopy; D002648:Child; D002675:Child, Preschool; D004724:Endoscopy / Q000009:adverse effects / Q000706:statistics & numerical data; D005260:Female; D005336:Fiber Optic Technology; D006801:Humans; D053685:Laser Therapy / Q000009:adverse effects / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D014132:Trachea / Q000601:surgery*; D014134:Tracheal Neoplasms / Q000601:surgery
Endoscopia operativa delle vie aeree.