Abstract：
OBJECTIVE: Benign (laryngo-)tracheal stenosis is a relatively rare pathology and its surgical treatment is performed only at few specialized centres. This study aims to investigate outcomes after (laryngo-)tracheal resection-anastomosis, to explore potential risk factors for postoperative complications and to assess whether, over a 33-year period, there were major changes in surgical indications, techniques or outcomes.
METHODS: Retrospective, single-centre review of all consecutive patients who underwent tracheal or laryngo-tracheal resection/anastomosis for benign pathologies from 1990 to 2023.
RESULTS: Overall, 211 patients underwent tracheal (149 patients, 70.6%) and laryngo-tracheal (62 patients, 29.4%) resection-anastomosis. Of these, 195 patients (93.8%) were affected by iatrogenic stenosis, while 13 (6.2%) suffered from idiopathic stenosis. The median length of stenosis was 25 mm (interquartile range 1-3, 20-30). The overall morbidity rate was 27.5%, while major morbidity occurred in 10.5% of cases. One patient (0.5%) died in the postoperative period. Glottic oedema (17 patients, 8.1%), granulations (12 patients, 5.7%) and restenosis (10 patients, 4.7%) were the main complications. The only independent risk factor for postoperative complications was the length of the resected airway (P = 0.019). In the latest half of the study period, an older median age was observed, and no patient with idiopathic tracheal stenosis underwent surgery. Postoperative outcomes were comparable between surgical eras.
CONCLUSIONS: Surgical treatment of (laryngo-)tracheal stenosis is challenging and should be performed by specialized centres. In our experience, morbidity and mortality rates were satisfactory, and in most cases, patients could breathe without tracheostomy. The length of the stenosis was the most significant risk factor for postoperative complications.
METHODS: Retrospective, single-centre review of all consecutive patients who underwent tracheal or laryngo-tracheal resection/anastomosis for benign pathologies from 1990 to 2023.
RESULTS: Overall, 211 patients underwent tracheal (149 patients, 70.6%) and laryngo-tracheal (62 patients, 29.4%) resection-anastomosis. Of these, 195 patients (93.8%) were affected by iatrogenic stenosis, while 13 (6.2%) suffered from idiopathic stenosis. The median length of stenosis was 25 mm (interquartile range 1-3, 20-30). The overall morbidity rate was 27.5%, while major morbidity occurred in 10.5% of cases. One patient (0.5%) died in the postoperative period. Glottic oedema (17 patients, 8.1%), granulations (12 patients, 5.7%) and restenosis (10 patients, 4.7%) were the main complications. The only independent risk factor for postoperative complications was the length of the resected airway (P = 0.019). In the latest half of the study period, an older median age was observed, and no patient with idiopathic tracheal stenosis underwent surgery. Postoperative outcomes were comparable between surgical eras.
CONCLUSIONS: Surgical treatment of (laryngo-)tracheal stenosis is challenging and should be performed by specialized centres. In our experience, morbidity and mortality rates were satisfactory, and in most cases, patients could breathe without tracheostomy. The length of the stenosis was the most significant risk factor for postoperative complications.
摘要：
目的：良性（喉-）气管狭窄是一种相对罕见的病理，其手术治疗仅在少数专门中心进行。本研究旨在调查（喉-）气管切除吻合术后的结果，探讨术后并发症的潜在危险因素,并评估是否，在33年的时间里，手术适应症发生了重大变化，技术或结果。
方法：回顾性，单中心回顾了1990年至2023年所有因良性病变而接受气管或喉-气管切除/吻合术的连续患者。
结果：总体而言，211例患者接受气管（149例患者，70.6%)和喉-气管(62例，29.4%)切除吻合。其中,195例患者（93.8%）受医源性狭窄影响，13例(6.2%)患有特发性狭窄。狭窄的中位长度为25mm[IQR1-3,20-30]。总发病率为27.5%，主要发病率为10.5%。术后死亡1例(0.5%)。声门性水肿（17例，8.1%），颗粒（12名患者，5.7％）和再狭窄（10例，4.7%)是主要并发症。术后并发症的唯一独立危险因素是切除的气道长度（p=0.019）。在最近一半的研究期间，观察到年龄中位数较大，特发性气管狭窄患者均未接受手术治疗。手术患者的术后结果具有可比性。
结论：（喉-）气管狭窄的外科治疗具有挑战性，应由专门的中心进行。根据我们的经验,发病率和死亡率令人满意，在大多数情况下，患者无需气管造口术即可呼吸。狭窄的长度是术后并发症的最重要危险因素。
方法：回顾性，单中心回顾了1990年至2023年所有因良性病变而接受气管或喉-气管切除/吻合术的连续患者。
结果：总体而言，211例患者接受气管（149例患者，70.6%)和喉-气管(62例，29.4%)切除吻合。其中,195例患者（93.8%）受医源性狭窄影响，13例(6.2%)患有特发性狭窄。狭窄的中位长度为25mm[IQR1-3,20-30]。总发病率为27.5%，主要发病率为10.5%。术后死亡1例(0.5%)。声门性水肿（17例，8.1%），颗粒（12名患者，5.7％）和再狭窄（10例，4.7%)是主要并发症。术后并发症的唯一独立危险因素是切除的气道长度（p=0.019）。在最近一半的研究期间，观察到年龄中位数较大，特发性气管狭窄患者均未接受手术治疗。手术患者的术后结果具有可比性。
结论：（喉-）气管狭窄的外科治疗具有挑战性，应由专门的中心进行。根据我们的经验,发病率和死亡率令人满意，在大多数情况下，患者无需气管造口术即可呼吸。狭窄的长度是术后并发症的最重要危险因素。
