[Tracheal stenosis: outcome analysis of the last 14 years].
Tracheal stenosis (TS) is an unusual and sometimes lethal condition. It's treatment is basically surgical and different techniques have been proposed.


OBJECTIVE
Analyze the outcome of patients with TS diagnosed and treated in our institution realted to the applied surgical technique during the study period.


METHODS
The clinical records of patients with TS (period 1991 to 2006) were reviewed analyzing the following variables: age, gender, associated malformations, intubation time, medium hospital stay and outcome. Patients were divided in 4 groups: conservative and endoscopic management (2 conservative, 1 dilatation, 1 laser), tracheal resection with termino-terminal anastomosis (RTA) (9 patients), tracheoplasties (slide or modified plasties) (20 patients) and anterior tracheoplasty with costal cartilage graft (TAIC) (6 patients). Results are expressed as media +/- standard error, comparative analysis was done using Chi square with continuity correction. Differences were considered statistically significant with a p < 0.05.


RESULTS
39 patients were reviewed (23 male, 16 female), medium age was 2.23 years. Associated malformations were: 12 vascular rings, 7 cardiac malformations, 4 Down syndromes, 1 pulmonary agenesia, 2 hemivertebtebrae, 1 renal agenesia and 1 cervicothoracic angiomatosis. Nineteen patients had short segment stenosis, 15 long segment stenosis (more than 1/3 of tracheal length) and 5 patients presented associated bronchial stenosis (most frequently right main bronchus). All TAIC failed: 4 deaths, 1 reestenosis and 1 persistent stenosis. In the tracheoplasty-group there were 2 exitus (1 due to a neurological lesion after a prolonged preoperative cardiorrespiratory arrest, one due to a surgical treatment delay with previous inadequate management). Patients treated with tracheoplasties and RTA had a favourable evolution and are asymptomatic in more than 80% of the cases after a mean follow-up of 59.9 +/- 7.4 months. In the conservative management group 2 patients died and 2 had a uneventful outcome. Global mortality was 20.5% (8 deaths). Differences observed in the mortality percentage between the study groups were statistically significant. (p = 0.0034) (50% in conservative management, 0% in RTA, 10% in tracheoplasties, 66.67% in TAIC). No statistically significant differences were found in the medium intubation time, medium hospital stay and medium follow-up time.


CONCLUSIONS
The fundamental treatment of the tracheal stenosis is the surgical approach. Patients should be studied with great detail taking into account associated malformations (mostly heart defects and vascular rings) and should be treated by a multidisciplinary group. Short segmental TS should be corrected with RTA, long TS with tracheoplasties (slide), remaining the TAIC technique obsolete.
Laín
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Unidad de Cirugía Torácica y Vía Aérea, Servicio de Cirugía Pediátrica, Hospital Gregorio Marañón, Madrid. alfhiler@yahoo.es
García-Casillas
M A
MA
Matute
J A
JA
Cañizo
A
A
Parente
A
A
Fanjul
M
M
Carrera
N
N
Vázquez
J
J