[Surgical treatment and endobronchial stentplacement for tuberculous tracheobronchial strictures]

We have seventeen cases of operation for the tuberculous tracheobronchial cicatric strictures. Ten of them were tracheobronchial reconstructions to the strictures, and other seven cases were resections of the peripheral destroyed or infected pulmonary tissues (lobectomy 1, pneumonectomy 6). In the reconstructions seven cases were of sleeve lobectomy (left 6, right 1), three were of segmental resection of left main bronchus and trachea. The results were good in 6 sleeve lobectomies and 2 segmental resections of left main bronchus. All these 8 cases had no marked tracheal strictures, and their postoperative troubles were mild. Two cases with tracheal stricture (left sleeve lobectomy and tracheal segmental resection with left pneumonectomy) suffered from postoperative major complications. In the former the tracheal stentplacement was needed for a long time, in the latter its tracheal anastomosis was disrupted and the patient died six months later. Peripheral pulmonary resections could get the good results to disappear their longstanding various symptoms and signs. We tried to do the endoscopic dilatation or stenting to three tracheal strictures. One case was treated by the endoscopic electrocauteries and baloon dilatations totally in 15 times, but its late prognosis was poor and the patient died of the ventilatory disturbance 53 months later. Another one was the case of left upper sleeve lobectomy with tracheal stricture, and already mentioned its tracheal stent. In the third case the tracheal wall was damaged so deeply and extensively that the tracheomalacia might cause to suffocate. Then the tracheal stricture had been dilated with several sized stents step by step, finally a silicon long T-tube was inserted into the trachea successfully. But 10 days later a hard mucous plug impacted inside the tube and the patient died. In recent Japanese literatures and meeting reports, there were sixty cases of endoscopic surgeries and stentplacement for tuberculous tracheobronchial strictures. In these cases about half ones were for the left main bronchus, one third for the trachea. In the former the rupture of bronchial wall happened in 6%, the dislocations of stent in 22% and restrictures came out in 26%. In the latter the complication death occurred in 14%, stent dislocations in 30% and restrictures in 46%, so it was only 30% to become to be free from tracheal stents.

For the treatment of tuberculous cicatric tracheobronchial strictures, the reconstruction of main bronchus in cases without marked tracheal stenosis is a good indication to regain the lost pulmonary function. The resection of peripheral lung is also a good indication to reduce many symptoms and signs from them. However various endoscopic treatments involving stentplacement has not been established yet enough, especially in a point of late prognosis, so we have to be careful to do such procedures. The new apparatus with more durable and easily handled will be expected to develop in near future.