In June 1987, a 19-year-old woman underwent emergency laser resection for an adenoid cy stic carcinoma involving the lower third of the trachea and both main stem bronchi. In the following two months, she required four more laser treatments because of repeated restenosis of the left bronchi causing acute respiratory insufficiency. Under these conditions radiotherapy could not be undertaken. On September 10, 1987, we decided to insert a stent in the left main stem bronchus. With the stent in place for two months, radiotherapy was carried out. However, after 6,000 rads, only marginal improvement was obtained. Because of worsening involvement of the trachea, a long stent extending from the trachea into the left main stein bronchus was inserted on December, 15, 1987 (Fig 4 and 5). When this stent was removed 71 days later, the bronchial wall collapsed. Prosthesis insertion was again necessary, but instead of one long prosthesis, two prostheses were inserted: one measuring 4 cm in length and 12 mm in diameter in the left main stem bronchus and one measuring 4 cm in length and 16 mm in diameter in the trachea. Because of continuing tumor growth, the bronchial stent had to be replaced every two months. The same tracheal stent is still in place. This woman has been intubated for 18 months and has a normal life at home.
In 1983, a 70-year-old woman suffered an iatrogenic tracheal injury leading to cicatricial tracheal stenosis. Sleeve resection was performed but she suffered relapse. Dilatation and laser resection failed due to the extent of the stenosis and associated tracheomalacia. A Montgomery T-tube was inserted and left in place for nearly five years. After removal of the T-tube, she suffered relapse and sleeve resection was again attempted. A week after surgery, restenosis occurred and emergency treatment was required. On March 3, 1988, we inserted an indwelling stent measuring 4 cm in length and 13 mm in diameter. She is now living normally at home (at one year follow-up). We plan to attempt removing the prosthesis after 18 months. levitra plus
FIGURE 4. Case 1. Endoscopy view in the tracheobronchial stent at the level of the carina.
FIGURE 5. Case 1. Computed tomography scan at the level of the carina. The ventilating port for the right main stem bronchus is clearly visible.
A 64-year-old man with squamous cell carcinoma of the middle third of the esophagus developed an esophagobronchial fistula. The left main stem bronchus was completely obstructed by an invading tumor and extrinsic compression. In a single session on May 13, 1988, an Atkinson prosthesis was inserted in the esophagus and a stent was placed in the bronchus after laser resection (Fig 6). Up until his death two months later from liver metastasis, he was able to eat and breathe normally.
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Figure 6. Case 3. Stent in place in the left main stem bronchus.