Abstract
This study investigated optimal treatment strategies for tracheal scar stenosis in 102 patients through a combination of endoscopic and surgical approaches. The research addressed the critical clinical challenge of managing varying stenosis severities, from critical decompensated cases to complex extended lesions. Our methodology employed a staged protocol beginning with endoscopic interventions including laser photodestruction and bougienage, which successfully converted critical stenoses to compensated forms in 51% of cases. Temporary stenting using Dumon stents (38.5%) and T-tubes (60.0%) was implemented in 26 patients for an average duration of 8 months, though with notable complication rates including 42.3% granulation formation and 11.5% stent migrations. Definitive surgical resection, performed in 24% of cases, demonstrated that prior endoscopic treatment did not increase resection length while improving operative conditions. The study population included patients with diverse stenosis locations: upper trachea (45.1%), thoracic segment (14.7%), and laryngotracheal complex (24.5%), representing a certain clinical complexity. The treatment algorithm achieved good long-term outcomes with 84% of patients maintaining good respiratory function (lumen >0.7 cm) during follow-up periods ranging from 6 months to 6 years, and a remarkably low 4% restenosis rate. Notably, patients with stenosis lengths exceeding 2 cm (65.4% of cases) particularly benefited from the staged approach, achieving comparable outcomes to those with shorter lesions. These findings establish that a tailored, stepwise approach incorporating endoscopic optimization before potential resection provides optimal outcomes, particularly for patients with comorbidities contraindicating immediate surgery.
Keywords: thoracic surgery, endosurgical treatment, plastic and reconstructive interventions.
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