Surgical Management of Tracheal Lesions

Since 1980 when we began applying endoscopical laser treatment for tracheo-bronchial lesions, the number of such cases has increased. There were 26 cases of tracheal lesions treated by surgical management and, these were divided into 2 groups : the resection/plastic group (group 1) and the tracheal tube stent group (group 2). Group 1 consisted of 6 cases of tracheal reconstruction (adenoid cystic carcinoma in 4 cases, scar proliferation after tracheal injury in 2 cases), 1 of carina reconstruction (adenoid cystic carcinoma), one case of extensive resection of the membranous portion with plasty (adenoid cystic carcinoma), and one case of tumor resection of the membranous portion without plasty (leiomyoma). The extent of trachea resection was 2.0-4.5 cm. Artificial vessels were used to cover the extensive defect of membranous portion of the trachea. The anastomotic portion of carina-reconstruction was covered by vertebral muscle to protect the suture line. This case had a good course.There were 12 malignant lesions and 5 benign scar/granulation lesions in 17 tracheal tube stent cases. Teflon straight tube was employed 13 times in 11 cases and silicone T tube was employed 12 times to 10 cases. Preoperative endoscopic Nd-YAG laser treatment was performed in 6 of 9 resected cases (66.7% of group 1) and 12 of 17 cases (92.3% of group 2). Cases which require tracheal surgical treatment usually have severe respiratory failure. In some of these cases the improvement the general condition by preoperative endoscopic laser treatment simplified postoperative management.