외인성 기관협착

최종욱,김용환,박정수,정광윤,민헌기,최건,Choi, Jong-Ouck,Kim, Yong-Whoan,Park, Jung-Soo,Jung, Kwang-Yoon,Min, Hun-Ki,Choi, Geon 대한기관식도과학회 1996 大韓氣管食道科學會誌 Vol.2 No.1

Tracheal stenosis can be classified into intrinsic stenosis secondary to tracheal inflammatory lesion or mass effect and extrinsic stenosis secondary tumors of thyroid, esophagus and mediastinum. Extrinsic stenosis which is frequently encountered in clinical setting could be often overlooked due to mild symptom. Recently, even with the increasing interest in extrinsic tracheal stenosis there are limitation in it's diagnosis and treatment. The purpose of this study is to provide guidance in the diagnosis and treaonent of extrinsic tracheal stenosis. Here, we report the etiology, symptoms, radiologic findings, pulmonary fuction finding, treatment and its results in 26 cases of extrinsic tracheal stenosis. Causes of extrinsic tracheal stenosis included compression of aiway by thyroid benign tumor in 13 cases to be the most common, next by thyroid malignancy in 9 cases, metastatic mediastinal turner in 2 cases, 1 case each for esophageal cancer and parathyroid cancer. In 3 cases simple tracheal resection and end to end anastomosis were done, 1 cases underwent total laryngectomy, and 8 cases were treated by conservative management, where all cases failed in treatment. The remaining 14 cases were successfully treated by removing the causes and maintaining tracheal tube insertion for amount of time. Extrinsic tracheal stenosis due to benign conditions were treated satisfactorily by removing mass, however with the malignant causes there was considerable amount of difficulty in treatment.

기관절제술후 기관 단단문합술 치험 결과

신동진,조우진,백승국,우정수,권순영,정광윤,Shin Dong-Jin,Cho Woo-Jin,Baek Sungkuk,Woo Jeong Su,Kwon Soon-Young,Jung Kwang-Yoon 대한기관식도과학회 2004 大韓氣管食道科學會誌 Vol.10 No.1

Tracheostomy and endotracheal intubation are often performed in patients with acute and chronic respiratory failure. Recently, the incidence of iatrogenic tracheal stenosis has increased. Tracheal resection and end-to-end anastomosis would be one of the most physiologic treatment options for severe tracheal stenosis. Also, this treatment can be applied to the management of trachea invaded by thyroid cancer and tracheal neoplasm. The authors aimed to analyze the outcomes of end-to-end anastomosis of trachea following segmental resection in tracheal stenosis and tracheal invasion of cancer that we have recently experienced. Materials and methods Authors retrospectively studied 19 cases treated by tracheal resection with end-to-end anastomosis between Feburuary 1996 and January 2003. 12 patients had tracheal stenosis, 6 patients had tracheal invasion by thryroid cancer and 1 patient had tracheal cancer. We analyzed the direct causes of tracheal stenosis, preoperative vocal cord function, operation technique, early and delayed postoperative complications, and the outcome of end-to-end anastomois. Result Decannulation without significant aspiration was achieved in 16 cases($89.5\%$). A 27 year-old man could not be decannulated because of restenosis. A 62 year-old woman could not be decannulated because of bilateral vocal cord palsy. Conclusion End-to-end anastomosis is a safe and effective surgical method for tracheal stenosis. Case selection for end-to-end anastomosis and preservation of recurrent laryngeal nerve during operation is very important.

외인성 기관협착

최종욱,김용환,박정수,정관윤,민헌기 한국의학사 1996 診斷과治療 Vol.16 No.5

기관절제 및 단단문합술에 의한 소아 기관협착증의 치료

최종욱,정근,김용환,김혜정,박찬,최건,Choi, Jong-Ouck,Chung, Keun,Kim, Young-Hwoan,Kim, Hye-Jung,Park, Chan,Choi, Geon 대한기관식도과학회 1997 大韓氣管食道科學會誌 Vol.3 No.1

Background and Objectives : In children with tracheal stenosis, operative management remains a challenging problem due to difficulties of operative techniques and postoperative care. The purpose of this study was to determine the effectiveness of tracheal resection with end to end anastomosis as operative management for tracheal stenosis in children. Materials and Methods : 6 children with severe tracheal stenosis underwent tracheal resection with end to end anastomosis. Causes of stenosis were trauma in 1 case and prolonged intubation or tracheotomy in 5 cases. The diagnoses were made by radiologic evaluation (plain X-ray, CT, 3-Dimensional CT) and confirmed by direct laryngoscopy and ventilating bronchoscopy under general anesthesia. Thyroplasty and unilateral arytenoidectomy were performed in 1 case. Suprahyoid release was done in 1 case with severe adhesion. Decanulation was achieved following postoperative endoscopic examination and pulmonary function test. Postoperative physical and radiologic examinations were given at regular intervals. Results : Stenosis were improved from grade III grade I in 4 cases and from grade II to grade I in 2 cases. Decanulation was achieved on average postoperative 6 months in 5 cases, and 10 years in 1 case due to exertional dyspnea. There were 1 each case of immediate postoperative subcutaneous emphysema, pneumothorax and wound infection. Postoperative granulomas at anastomosis site were treated with laser vaporization under suspension laryngoscope and bronchoscope in 3 cases. There was 1 each case of delayed postoperative vocal cord palsy, aspiration pneumonia and loss of cough reflex. Conclusion In tracheal stenosis of children, tracheal resection with end to end anastomosis has good result with preservation of normal airway. Preoperative evaluation of local factors such as swallowing, vocal cord movement and cough reflex and general condition was important for successful treatment. As the cases in adults, authors considered this operation to be a curable operative management for tracheal stenosis.

분절된 튜브의 기도 내 삽입에 의한 기도협착 동물 모델

임수진,김성원,이강대,김서빈,전석원,옥철호,정민정,황치우,이형신 대한이비인후과학회 2016 대한이비인후과학회지 두경부외과학 Vol.59 No.8

Background and Objectives Various methods to induce tracheal stenosis in an animal model have been introduced. However, most methods use non-physiologic mechanical or chemical injury to tracheal mucosa or cartilage. In this study, we sought to develop an animal model of tracheal stenosis using a segmented endotracheal tube. Materials and Method Nine New Zealand White Rabbits were included in this feasibility study. A segmented 1.5 cm LEVIN-Tube (16 French) was inserted into tracheal lumen via tracheotomy site and fixed with a nylon tape circumferentially tied around the trachea. The tube was removed transorally one week later and the tracheal lumen was observed with bronchoscopy every week. Rabbits were sacrificed two weeks after the tube removal and the trachea was evaluated with histologic image. Three rabbits underwent tracheotomy and closure only to evaluate possible impact of tracheotomy procedure to tracheal stenosis (sham surgery). Results None of the 6 rabbits showed significant complications or death during the study. No significant change of tracheal lumen was identified in 3 sham models. The mean grade of stenosis was 57.2±9.9% (range, 43-70%). Histologic image showed thickening and fibrosis of lamina propria with relatively intact tracheal cartilage framework. Conclusion We developed an animal model of tracheal stenosis using a segmented endotracheal tube fixed with a nylon tape. Since this model has similar pathophysiology to prolonged endotracheal intubation, it may be used in various studies related to tracheal stenosis. Korean J Otorhinolaryngol-Head Neck Surg 2016;59(8):599-603

기관협착증에서 3차원적 영상 진단의 의의

정동학,봉정표,이운우,노정래,성기준 대한기관식도과학회 1995 大韓氣管食道科學會誌 Vol.1 No.1

Three-dimensional reconstruction of computed tomographic image(3D CT) is a well-established imaging modality which has been investigated in various clinical settings. It is commonly performed in case of congenital or developmental abnormalities, and traumatic fracture of skull and face that requires reconstruction of osseous structure. However reporting the 3D CT in laryngeal or tracheal stenosis is rare and its results are obscure. The authors performed 3D CT in six cases of tracheal stenosis and found diagnostic value of 3D CT. A Comparision of diagnostic information obtained from plain X-ray, 2D CT and 3D CT has performed in total six cases of tracheal stenosis. Surgical treatment of the tracheal stenosis was following in these cases : tracheal end to end anastomosis In 1 case, laryngotracheal end to end anastomosis in 2 cases. 3D CT information was compared with operative finding. In two of six cases, satisfactory information was not obtained from 3D CT in evaluating an exact stenosis of trachea. Future, it will be helped in evaluating of tracheal stenosis by 3D CT.

기관절제 및 단단문합술에 의한 소아 기관협착증의 치료

최종욱,정근,김용환,김혜정,박찬,최건 한국의학사 1997 診斷과治療 Vol.17 No.7

기관 삽관후 발생한 기관 협착 -치험 1례-

현성열 ( Sung Youl Hyun ),강영준 ( Young Joon Kang ),김진주 ( Jin Joo Kim ),김용인 ( Yong In Kim ),김재광 ( Jae Kwang Kim ),임용수 ( Yong Su Lim ),양혁준 ( Hyuk Joon Yang ),서태석 ( Tae Suk Seo ),박희권 ( Hee Kwon Park ),이석기 ( 대한외상학회 2004 大韓外傷學會誌 Vol.17 No.2

Tracheal intubation is the most common cause of Tracheal stenosis. The treatment of trachea stenosis vary according to site or size of tracheal stenosis. Thirty six age old man was transferred our hospital for evaluation of dyspnea. Subglottic stenosis was shown on bronchoscopy & chest computerized tomography(CT) scan of neck. Balloon dilatation was performed and then patient breathed at ease. Tracheal resection and end-to-end anastomosis was applied to repetitive tracheal stenosis. Balloon dilatation before surgical management makes better respiratory difficulty. We report succesful application of surgical management after balloon dilatation in repetitive tracheal stenosis patient. We will suggest that the balloon dilatation improve symptoms before tracheal resection and end-to-end anastomosis or stent, if sugery or stent insertion are not applicable due to poor status of patient.

기관내 삽관 후 환형의 기관 갈퀴막 형성으로 인한 기도 폐쇄 -증례 보고-

정미영,송호경 대한마취통증의학회 2011 Anesthesia and pain medicine Vol.6 No.4

Tracheal stenosis is well known complication of endotracheal intubation. However, severe post intubation tracheal stenosis that requires interventional bronchoscopy or tracheal surgery is un-common. Necrosis induced by cuff pressure-related loss of regional blood flow is the central injury leading to postinubation tracheal stenosis. The large volume, low pressure cuff of endo-tracheal tubes have markedly reduced the occurrence cuff-induced injury. However, in any patient who develops symptoms of airway obstruction, who has been intubated and ventilated in the recent past, possibility of tracheal stenosis should be considered. We report a case of severe tracheal stenosis by tracheal web formation a 52-year-old following ventilator therapy for ARDS.

Laser therapy in patients with suprastomal tracheal stenosis after tracheostomy

( Ki Hyun Seo ),( Cheol Kim ),( Ji Hyun Oh ),( Ji Won Lyu ),( Ho Sung Lee ),( Jae Sung Choi ),( Ju Ock Na ),( Yong Hoon Kim ) 대한결핵 및 호흡기학회 2019 대한결핵 및 호흡기학회 추계학술대회 초록집 Vol.127 No.-

Background: Tracheal stenosis after some of the classical non-flap surgical tracheostomy was observed cranial to the tracheostoma and consisted of scar and granulation tissue. Operation is associated with significant morbidity and a low mortality rate, although tracheal resection and end-to-end anastomosis has been recommended to treat this condition. Alternatively, laser surgery could allow the immediate coagulation and resection of tracheal stenosis without recurrence. The purpose of this study is to evaluate the safety and effectiveness of diode laser therapy in patients with suprastomal tracheal stenosis after tracheostomy accompanied with severe cough, dyspnea. Methods: A prospective analysis of patients who underwent laser therapy during the 5-yearh period was performed. We investigated the result of treatment before and after procedure as well as the recurrence of stenosis. Results: Eighteen patients underwent the first laser session and one patient received the second session 2.4 years after laser therapy by a otolaryngologist. The mean age of the patients was 54.5 ± 17.4 years (13 males, 6 females; age range: 9 - 77 years). All of patients except one patient performed the removal of granuloma with a large forcep after one session of laser treatment without complication. Six months after the laser ablation, 16 of 17 patients had much improvement of symptoms with a complete recanalization. In addition, 13 of 14 patients who attempted decannulation were successful. Conclusion: The laser resection in patients with suprastomal tracheal stenosis after tracheostomy was a highly effective, safe, long-standing therapeutic method with its immediate visible effect.