Kirurško liječnje postintubacijske stenoze traheje

master's thesis

• Title (english): Surgical treatment of postintubation tracheal stenosis
• Author: Filip Miletić
• Mentor: Zoran Slobodnjak (mentor)
• Committee member: Dubravko Jalšovec (predsjednik povjerenstva)
• Committee member: Tomislav Meštrović (član povjerenstva)
• Committee member: Zoran Slobodnjak (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Surgery); Zagreb
• Defense date and country: 2014-07-15, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Surgery

Abstract

Svrha ovog rada je prikazati etiološke čimbenike i patogenetske mehanizme koji
dovode do razvoja postintubacijske stenoze traheje te opisati kliničku sliku i metode
kirurškog liječenja s posebnim naglaskom na anteriorni pristup.
Povećano korištenje endotrahealnih tubusa za toaletu dišnih puteva, sprječavanje
aspiracije i omogućavanje mehaničke potpore disanju pri zatajenju disanja, jedan je
od čimbenika nastalih lezija dišnih puteva koje se mogu nalaziti na različitim
razinama, od nosnica do dijelišta dušnika. Kliničke karakteristike variraju od
faringitisa do potpune opstrukcije dišnog puta ili krvarenja s asfiksijom. Spomenute
lezije nazivamo stenozama dišnog puta i torakalni kirurg mora ih poznavati. Kada
govorimo o stenozama dušnika, bitno je istaknuti nekoliko razina na kojima se mogu
pojaviti. Te razine su: stomalna, mjesto gdje je bila smještena manšeta na
napuhavanje, segment dušnika između stomalne razine i razine smještanja manšete
te mjesto gdje vrh endotrahealnog tubusa može pritiskati zid traheje. Većina
pacijenata s postintubacijskim stenozama dušnika klinički se predstavljaju znacima
opstrukcije dišnog puta. Glavna očitovanja su: progresivna dispneja, piskanje i šum
te isprekidana opstrukcija sa zadržavanjem sekrecija. U dijagnostičkom smislu,
potrebno je obratiti pozornost na kliničku sliku, analizirati konvencionalne radiološke
slike i nalaze kompjutorizirane tomografije te na temelju toga učiniti bronhoskopiju.
Budući da su pacijenti ventilirani endotrahealnim tubusom, grkljan i dušnik mogu
pretrpjeti trajne ozljede i mogu se razviti opsežne komplikacije. U takvim stanjima
koristimo se metodama konzervativnog i kirurškog liječenja. Pri operativnom zahvatu
postintubacijske stenoze dušnika, u većini slučajeva, koristi se tvz. prednji (anteriorni)
pristup. U drugim slučajevima koristi se i desna posterolateralna torakotomija,
ponekad i lijeva, uglavnom zbog slabije izloženosti karine od strane aorte, koja je
ispred lijevog hilusa.

Abstract (english)

The aim of this paper is to present etiological factors and pathogenic mechanisms
which lead to the development of postintubation tracheal stenosis as well as to
describe the clinical picture and methods of surgical treatment with the emphasis on
the anterior approach.
The increasing use of endotracheal tracheostomy tubes for the treatment of
secretions, the prevention of aspiration and the delivery of mechanical ventilatory
support for the respiratory breakdown is one of the factors which produce a whole
range of airway lesions located from nostrils to the bifurcation of trachea. Clinical
characteristics range from pharyngitis to a complete obstruction of the airway or
asphyxiating haemorrhage. These lesions are known as tracheal stenoses and a
thoracic surgeon must become familiar with them. Tracheal stenosis can occur at
each level. These levels are: stomal, the site where the inflatable cuff rested, the
segment between the stoma and the level of the cuff and the locus where the tip of
the tube may impinge on the tracheal wall. The majority of patients with tracheal
stenosis clinically show signs of obstruction. The main signs are progressive
dyspnea, wheezing and stridor and an intermittent obstruction with retention of
secretions. In terms of diagnostics, it is necessary to pay attention to the clinical
picture, analyse conventional radiologic and computed tomography (CT) images and,
on the basis of the findings, perform bronchoscopy. Since the patients are ventilated
through endotracheal tube, the larynx and trachea may develop extensive
complications which demand adequate conservative and surgical treatment. In
surgery, the anterior approach is most commonly used. In other cases right
posterolateral thoracotomy is more often used than left thoracotomy, mainly because
of the fact that the carina is less exposed since the aorta is located in front of the left
hilum.

• Keywords: postintubacijska stenoza traheje; anteriorni pristup
• Keywords (english): postintubation tracheal stenosis; anterior approach
• Language: croatian
• URN:NBN: urn:nbn:hr:105:851076
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2016-03-14 13:04:13