M.YU. ULUPOV, M.A. RYABOV, M.E. MALKOVA

The first St. Petersburg State Medical University named after academician I.P. Pavlov, 6-8 Lva Tolstogo St., St. Petersburg, Russian Federation, 197022

Ryabova M.A. ― Doc. Med. Sc., Professor of the Department of Otorhinolaryngology with the clinic, e-mail: marinaryabova@mail.ru

Ulupov M.Yu. ― Cand. Med. Sc., Associate Professor of the Department of Otorhinolaryngology with the clinic, e-mail: mike.ulupov@gmail.com

Malkova M.E. ― Post-graduate student of the Department of Otorhinolaryngology with the clinic, e-mail: malkovusha@mail.ru

This work is aimed at estimation of efficiency and safety of endoscopic surgery by the means of 980 nm diode laser with subsequent balloon dilatation of non-tumor stenosis of the larynx or trachea. The analysis of results of treatment by the method of endoscopic laser surgery and balloon dilatation of 32 patients (10 men and 22 women) with non-tumor laryngotracheal stenosis was carried out. Stenosis was located in the larynx and/or in the upper third of the trachea (31 of 32 patients), a length of 5 to 40 mm, and 2-3 degrees according to the Cotton-Myer classification. In the conditions of general anesthesia of high-frequency jet ventilation of the lungs, four radial incisions were made using a diode laser in the pulsed mode, followed by a double expansion of the balloon. The number of surgeries varied from 1 to 4 (total of 55 operations), the median interval between interventions was 22 weeks. At the end of the surgery in 14 cases a four-minute 0.4 mg/ml mitomycin C application was made, in 6 cases ― triamcinolone 40 mg/ml local injections, in 3 cases ― both variants. Results: Two major complications were observed: intraoperative tracheal wall rupture, which was healed spontaneously, and laryngeal edema 3 hours after surgery, which required urgent tracheotomy. Statistically significant increase in PEF was achieved from 2.0 ± 1.0 l / s to 4.7 ± 1.9 l / s (p = 0.000). Fourteen of sixteen patients were successfully decannulated. Local adjuvant therapy did not significantly affected PEF increase and decannulation rate (p = 0.22, 0.69).

Endoscopic laser surgery with subsequent balloon dilatation is a safe and effective method for treatment of laryngotracheal stenosis.

Key words: laryngotracheal stenosis, balloon dilatation, laser surgery.

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