Análise dos procedimentos utilizados na correção das estenoses traqueais adquiridas
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2021-07-29
Autores
Aguiar, Ivana Teixeira de
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Universidade Estadual Paulista (Unesp)
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Introdução: As estenoses traqueais adquiridas são principalmente decorrentes de intubação endotraqueal prolongada. Existem vários procedimentos utilizados para a correção das estenoses e essa escolha deve ser individualizada para cada paciente, de acordo com suas características clínicas e da estenose. Objetivos: Avaliar a forma de apresentação, evolução e procedimentos utilizados para a correção das estenoses traqueais adquiridas no Serviço de Cirurgia Torácica do Hospital das Clínicas da Faculdade de Medicina de Botucatu e avaliar a efetividade do protocolo de atendimento e tratamento desses pacientes com base na experiência do serviço. Métodos: Estudo observacional retrospectivo (série de casos), pela análise de prontuários. Foram avaliadas características demográficas e clínicas dos pacientes, características anatômicas da estenose e particularidades dos tratamentos realizados, bem como os desfechos favorável e desfavorável. Resultados: Foram avaliados 90 pacientes. A maioria era do sexo masculino (70%), com uma média de idade de 31 (± 15,9) anos. A intubação prolongada foi a etiologia em 94,4% dos casos. A queixa principal em 62 pacientes foi a dispneia. Mais da metade dos pacientes já foi encaminhada com traqueostomia. Dez dos pacientes eram de Botucatu, 18 de regiões próximas e os demais de outras regiões de saúde e de outros estados. Quarenta e seis pacientes foram submetidos a cirurgia e quinze necessitaram de tratamento endoscópico posteriormente para resolução de complicações. Foram observadas 19 complicações: reestenoses (10), paralisia de pregas vocais (2), estenose de laringe (2), insuficiência respiratória (2), traqueomalácia (1), fístula traqueocutânea (1) e síndrome medular completa (1). O desfecho foi favorável em 91,3% dos pacientes e 8,7% tiveram desfecho desfavorável. No grupo endoscópico, foram 44 pacientes, sendo 42 deles submetidos à dilatação traqueal, com aplicação de mitomicina em 21. Trinta e três pacientes utilizaram órtese, foram 27 tubos T de Montgomery, 5 cânulas de traqueostomia, 2 órteses de Dumon e 1 tubo em Y. Nesse grupo, 27 (61,4%) dos pacientes tiveram desfecho favorável e 17 (38,6%), desfavorável. Conclusão: O tratamento cirúrgico é a melhor opção para estenose traqueal quando comparado ao tratamento endoscópico. O protocolo de atendimento do serviço se mostrou satisfatório com dados de resolução da condição semelhantes aos da literatura. Dessa forma, reforçamos o seguimento do algoritmo, já utilizado no serviço, para obtenção de resultados satisfatórios.
Introduction: Acquired tracheal stenoses are mainly due to prolonged endotracheal intubation. There are several procedures used to correct stenoses and this choice must be individualized for each patient, according to their clinical and stenosis characteristics. Objectives: To evaluate the presentation, evolution and procedures used for the correction of acquired tracheal stenosis in the Thoracic Surgery Service at the Hospital das Clínicas da Faculdade de Medicina de Botucatu and to evaluate the effectiveness of the protocol for the care and treatment of these patients based on experience of the service. Methods: Retrospective observational study (cases series), with analysis of medical records. Demographic and clinical characteristics of the patients, anatomical characteristics of the stenosis and particularity of the treatments performed were evaluated, as well as the results. Results: 90 patients were evaluated. Most were male (70%), with a mean age of 31 (± 15.9) Years. Prolonged intubation was the etiology in 94.4%. The main complaint in 62 patients was dyspnea. More than half of patients have been referred with tracheostomy. Ten of the patients were from Botucatu, 18 from nearby regions and the rest from other health regions and other states. Forty-six patients underwent surgery and fifteen required subsequent endoscopic treatment to resolve complications. Nineteen complications were observed: restenosis (10), vocal fold paralysis (2), laryngeal stenosis (2), respiratory failure (2), tracheomalacia (1), tracheocutaneous fistula (1) and complete spinal cord syndrome (1). We had 91.3% of patients with a favorable outcome and 8.7% had an unfavorable outcome. In the Endoscopic group, there were 44 patients, 42 of whom underwent tracheal dilatation, with application of mitomycin in 21. Thirty-three patients used orthosis, 27 Montgomery T tubes, 5 tracheostomy tubes, 2 Dumon orthoses and 1 tube in Y. In this group, 27 (61.4%) of the patients had a favorable outcome and 17 (38.6%) had an unfavorable outcome. Conclusion: Surgical treatment is the best option for tracheal stenosis when compared to endoscopic treatment. The service's protocol was satisfactory, with data on the resolution of the condition similar and even better than in the literature. Thus, we reinforce the follow-up of the algorithm, already used in the service, to obtain satisfactory results.
Introduction: Acquired tracheal stenoses are mainly due to prolonged endotracheal intubation. There are several procedures used to correct stenoses and this choice must be individualized for each patient, according to their clinical and stenosis characteristics. Objectives: To evaluate the presentation, evolution and procedures used for the correction of acquired tracheal stenosis in the Thoracic Surgery Service at the Hospital das Clínicas da Faculdade de Medicina de Botucatu and to evaluate the effectiveness of the protocol for the care and treatment of these patients based on experience of the service. Methods: Retrospective observational study (cases series), with analysis of medical records. Demographic and clinical characteristics of the patients, anatomical characteristics of the stenosis and particularity of the treatments performed were evaluated, as well as the results. Results: 90 patients were evaluated. Most were male (70%), with a mean age of 31 (± 15.9) Years. Prolonged intubation was the etiology in 94.4%. The main complaint in 62 patients was dyspnea. More than half of patients have been referred with tracheostomy. Ten of the patients were from Botucatu, 18 from nearby regions and the rest from other health regions and other states. Forty-six patients underwent surgery and fifteen required subsequent endoscopic treatment to resolve complications. Nineteen complications were observed: restenosis (10), vocal fold paralysis (2), laryngeal stenosis (2), respiratory failure (2), tracheomalacia (1), tracheocutaneous fistula (1) and complete spinal cord syndrome (1). We had 91.3% of patients with a favorable outcome and 8.7% had an unfavorable outcome. In the Endoscopic group, there were 44 patients, 42 of whom underwent tracheal dilatation, with application of mitomycin in 21. Thirty-three patients used orthosis, 27 Montgomery T tubes, 5 tracheostomy tubes, 2 Dumon orthoses and 1 tube in Y. In this group, 27 (61.4%) of the patients had a favorable outcome and 17 (38.6%) had an unfavorable outcome. Conclusion: Surgical treatment is the best option for tracheal stenosis when compared to endoscopic treatment. The service's protocol was satisfactory, with data on the resolution of the condition similar and even better than in the literature. Thus, we reinforce the follow-up of the algorithm, already used in the service, to obtain satisfactory results.
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Traqueia, Estenose, Intubação, Trachea, Stenoses, Intubation