1Thoracic division, NAtional research centre of surgery, Moscow, Russian Federation
Background. Surgical treatment of total stenoses of a trachea remains a difficult problem of thoracic surgery. Interventions available in an arsenal not always can considerably help the patient with incurable stenosis of a trachea. Transplantation of trachea appeared to be saving procedure for this group of patients.
Aims. To study long term results of 2 cases of tracheal transplantation (TT) performed in patients with subtotal tracheal stenosis.
Materials and methods. 37 y.o. male patient with tracheostomy, subtotal stenosis of trachea and stridor had undergone transplantation of trachea with revisualization in 2006. Patient was discharged with free breathing, without tracheostoma and fever. In 3 years after procedure he had undergone stenting on lower part of donor trachea because of compression from outside probably by donor thyreoid gland. In 4 years after TTR patient breathing well. His immunosupression regimen include cyclosporine A 200 mg/d, methylprednisolone 2 mg/d, mofetyl mycofelonate 2 g/d. He had evaluated quality of life as good. In 7 y after TT he is still with tracheal stent, receiving same immunosupression, but lower dose of MMF. And bronchoscopy revealed tracheal esophageal fistula without clinical signs on level of upper end of stent.
25 y.o. female with subtotal stenosis of trachea, stridor and “Polyflex” stent had undergone transplantation of trachea received by methods of regenerative medicine in 2010. The early postoperative period was accompanied by the moderate respiratory insufficiency, hemoptysis, expressed bronchial secretion. Sinus tachycardia and high levels of red blood and white blood cells, C-reactive protein and procalcitotnin have been connected with introduction of growth factors. By the moment of discharge breath was free, a gleam of trachea on all extent was satisfactory, in transplant wall we revealed squamous cell ephitelium. Patient does not require immunosupression. In 6 m. we observed progressive deterioration of breathing and revealed stenosis of tracheal transplant. We need to perform tracheoplasty with T-tube. Twice we try to detubate patient but in short period restenosis occurred. So patient continue having T-tube in trachea.
Conclusions. In some patients with critical subtotal stenosis resistant to accepted management tracheal transplantation may be curative option with satisfactory short-term results. Long term results occur challenges either to patients or doctors and need a lot of efforts to control specific conditions.
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