Reconstructive Surgery for Inflammatory Stricture of the Trachea and Bronchus

Abstract

Inflammatory stricture of the tracheobronchial tree is relatively rare incidence compared with that caused by neoplasm. In contrast to neopastic air way strictures, there are several unresolved problems concerning the reconstructive surgery of the inflammatory stricture, such as operative indication, time of operation, extent of resection, or operative procedure. Clinical analysis was done regarding the cases undergone reconstructive surgery, the cases undergone extensive resection, and the cases without surgical intervention. During the past ten years there were twelve cases of air way inflammatory stricture, 4 of the trachea and 8 of the bronchus. The etiology was nonspecific inflammation in five cases and tuberculous inflammation in seven. The former included two cases of posttracheostomy stricture and three cases of stricture caused by granulation formation after tracheobronchial reconstruction. For the two cases of posttracheostomy stricture at the stoma and tube tip levels, tracheal reconstruction was performed after resection of two and three cartilage rings, respectively. Among the three cases of strictures caused by granulation formation after reconstructive surgery, forceps resection and electrosurgery were successful in two cases, however in one case endoscopic treatment failed and rereconstructive surgery was performed with satisfactory results. Recently the incidence of iatrogenic air way strictures is increasing. Since endoscopic excision by methods including biopsy forceps removal, electrosurgery or cryosurgery, limited can provide satisfactory results only in cases of stricture, reconstructive surgery is indicated in most cases. Of the seven cases of tuberculous strictures, the right upper bronchus was involved in three cases, the main and right upper bronchus in one case, and the left main bronchus in three cases. These strictures were mostly induced by cicatricial formation by nonspecific granular tissue after healing of tuberculous bronchitis by cicatricial anti-tuberculous treatment. For the three cases of cicatricial stricture confined to the orifice of the right upper bronchus with no evidence of inflammatory changes of the main bronchus verified by bronchoscopic biopsies, right upper lobes containing tuberculous cavities were resected without any postoperative complication. However, the case of right upper bronchus obstruction with inflammatory changes in the main bronchus underwent sleeve upper lobectomy by resecting the right main bronchus with concomitant dissection of the tuberculous lymph nodes compressing, the wall of the main bronchus. One case developed atelectasis of the entire left lung due to cicatricial occlusion of the main bronchus during antituberculous treatment, pneumonectomy was inevitable, for the whole lung tissue were replaced by the irreversible cystic bronchiectasis occurring secondarily to the bronchial obstruction. In addition tubercles in the lung parenchyma were scarce. There are two cases under observation with non-symptomatic localized strictures in the left main bronchus caused by cicatricial formation after treatment of tuberculous bronchitis. Because of experience with the above-mentioned cases undergoing pneumonectomy, periodical observations and biopsies are performed for these cases with intermittent examination of perfusion and ventilation scans to evaluate operability. We are considering bronchoplastic surgery if symptoms are getting clear in the future.