의인성 기관협착증에 관한 임상적 고찰

Background and objectives: Incidence of iatrogenic tracheal stenosis is certainly on its uphill curve as being reported by domestic and foreign head and neck surgeons. With a recent advancement in surgical technique and application of optimal care, injury due to cuffing outnumbers direct injury due to intubation and tracheotomy. Authors analyzed 20 cases of iatrogenic tracheal stenosis on their etiologies and treatment options to help prevent them and promote better modes of treatment afterward.

Materials and Methods: Twenty patients from 1986 to 1997 with tracheal stenosis caused by iatrogenic surgical or intubational procedures were retrospectively reviewed.

Results: Of 20 cases, 13 cases turned out to be tracheotomy-related (7 by cuffing trauma, 4 by surgical procedure, 2 by tube tip irritation), 4 purely intubation-related and 3 cases were believed to be related to both tracheotomy and intubation. Stenting with removal of some granulation tissue helped in 3 cases. T-tube stenting were tried in 9 cases and 3 of them were failed and 2 were finally treated by end-to-end anastomosis and 1 was transferred to thoracic surgeon for open thoracotomy. Sleeve resection and end-to-end anastomosis of trachea was tried in 11 cases and cured all of them.

Conclusion: Careless management of cuffing, both in intubation and tracheotomy tube, was a leading cause of iatrogenic tracheal stenosis. Sleeve resection and end-to-end anastomosis was performed in over 50% (11 cases) and turned out to be a procedure of choice in cases otherwise failed and in tracheal stenosis of relatively long segment. Early concern and intervention of otolaryngologist is highly recommanded in the management of patient with causative ailments requiring airway handling.