Enfermedades quirúrgicas de la tráquea.
La tráquea es la tráquea que transporta el aire desde la boca hasta los pulmones. Está conectado arriba en el cuello con la laringe (“la nuez de Adán”) y debajo, en el pecho, se divide en los bronquios izquierdo y derecho, que se conectan a cada pulmón. Los cirujanos del Departamento de Cirugía Torácica y Trasplante de Pulmón del Centro Médico de la Universidad de Baylor, parte de Baylor Scott & White Health en Dallas, diagnostican y tratan una variedad de enfermedades que afectan la tráquea.
Tipos de enfermedades
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Condiciones benignas
Condiciones benignas
- Tracheal stenosis—A narrowing of the trachea, most commonly following the placement of a breathing tube (intubation) or previous surgery. Babies can also be born with this condition, but most adult cases develop due to the growth of scar tissue during prolonged placement of a breathing tube or following tracheostomy, a surgically created opening in the neck for breathing. The trachea can also be externally compressed by other structures, most commonly tumors of the thyroid gland and esophagus.
- Tracheal inflammation—Several autoimmune disorders and infections may cause the trachea to become swollen and inflamed, essentially blocking airflow similar to tracheal stenosis. These include Wegener’s granulomatosis, sarcoidosis and amyloidosis. It can also occur as a side effect of radiation therapy to the head, neck or chest for other conditions.
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Tumores benignos
Tumores benignos
Los tumores benignos en la tráquea y los bronquios son mucho menos comunes que los tumores en órganos o tejidos cercanos que luego afectan la tráquea:
- Carcinoid tumors—More commonly found in the bronchi than the trachea, they occur most often between the ages of 40-60 years, are not associated with smoking, and can produce hormones that cause other systemic symptoms in the heart and gastrointestinal tract.
- Papillomas—Benign growths associated with human papillomavirus (HPV), they often grow in groups (referred to as papillomatosis) and can carry the risk of transforming into squamous cell carcinoma.
- Chondroma—A very rare tumor that grows from the cartilage portion of the airway.
- Hemangioma—Tumors of the airway blood vessels that can cause significant bleeding if rupture or during surgical manipulation.
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Cáncer en órganos adyacentes.
Cáncer en órganos adyacentes.
El cáncer en los órganos y glándulas que rodean las vías respiratorias puede afectar el paso del aire a través de la tráquea:
- Thyroid gland—Benign goiter, as well as cancer of the thyroid gland, can compress the trachea in the neck or chest region and cause shortness of breath.
- Esophagus—The “food pipe” sits directly next to the trachea. Cancers of this organ can grow into the airway; develop abnormal communication with the airway (fistula); and treating of this condition with radiation therapy or stents can damage the airway.
- Lung—Lungs communicate directly with the airway at the level of the bronchi, but tumors of the upper part of the lung, as well as abnormal lymph nodes in the chest, can compress the trachea
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Tumores malignos (cancerosos) de la tráquea y los bronquios.
Tumores malignos (cancerosos) de la tráquea y los bronquios.
- Squamous cell carcinoma—The most common type of tracheal tumor, it usually grows in the lower part of the trachea and tends to grow quickly and cause bleeding and shortness of breath. Smoking is the main risk factor.
- Adenoid cystic carcinoma—Much less common, these tumors grow slowly and are not associated with smoking.
Condiciones benignas
- Tracheal stenosis—A narrowing of the trachea, most commonly following the placement of a breathing tube (intubation) or previous surgery. Babies can also be born with this condition, but most adult cases develop due to the growth of scar tissue during prolonged placement of a breathing tube or following tracheostomy, a surgically created opening in the neck for breathing. The trachea can also be externally compressed by other structures, most commonly tumors of the thyroid gland and esophagus.
- Tracheal inflammation—Several autoimmune disorders and infections may cause the trachea to become swollen and inflamed, essentially blocking airflow similar to tracheal stenosis. These include Wegener’s granulomatosis, sarcoidosis and amyloidosis. It can also occur as a side effect of radiation therapy to the head, neck or chest for other conditions.
Tumores benignos
Los tumores benignos en la tráquea y los bronquios son mucho menos comunes que los tumores en órganos o tejidos cercanos que luego afectan la tráquea:
- Carcinoid tumors—More commonly found in the bronchi than the trachea, they occur most often between the ages of 40-60 years, are not associated with smoking, and can produce hormones that cause other systemic symptoms in the heart and gastrointestinal tract.
- Papillomas—Benign growths associated with human papillomavirus (HPV), they often grow in groups (referred to as papillomatosis) and can carry the risk of transforming into squamous cell carcinoma.
- Chondroma—A very rare tumor that grows from the cartilage portion of the airway.
- Hemangioma—Tumors of the airway blood vessels that can cause significant bleeding if rupture or during surgical manipulation.
Cáncer en órganos adyacentes.
El cáncer en los órganos y glándulas que rodean las vías respiratorias puede afectar el paso del aire a través de la tráquea:
- Thyroid gland—Benign goiter, as well as cancer of the thyroid gland, can compress the trachea in the neck or chest region and cause shortness of breath.
- Esophagus—The “food pipe” sits directly next to the trachea. Cancers of this organ can grow into the airway; develop abnormal communication with the airway (fistula); and treating of this condition with radiation therapy or stents can damage the airway.
- Lung—Lungs communicate directly with the airway at the level of the bronchi, but tumors of the upper part of the lung, as well as abnormal lymph nodes in the chest, can compress the trachea
Tumores malignos (cancerosos) de la tráquea y los bronquios.
- Squamous cell carcinoma—The most common type of tracheal tumor, it usually grows in the lower part of the trachea and tends to grow quickly and cause bleeding and shortness of breath. Smoking is the main risk factor.
- Adenoid cystic carcinoma—Much less common, these tumors grow slowly and are not associated with smoking.
Diagnóstico de enfermedades en la tráquea.
La evaluación de enfermedades en la tráquea o los bronquios se puede realizar mediante una combinación de pruebas invasivas y no invasivas.
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Pruebas no invasivas
- Pulmonary function test—Determines how much air can be breathed in and out and helps classify types of airway and lung diseases. It can also be used to assess the muscles of the chest wall and mechanics of breathing.
- ultrasonido—Uses sonography to see inside the body. It is particularly useful for assessing the thyroid gland when it is abnormally large and impinging on the trachea.
- CT (computed tomography)—Uses X-ray images to create virtual images of the inside of the body. It is essential in the diagnosis of airway and lung diseases. Advanced 3D reconstructions are particularly useful in planning treatment for airway conditions.
- PET (positron emission tomography)—A scan using an injected dye to assess metabolic activity and detect the likelihood of cancer.
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Pruebas invasivas
- Endoscopy—Fiber optic tubes that are inserted through the mouth or nose and provide a high-definition image to the surgeon, allowing direct visualization inside the body. A bronchoscopy allows the surgeon to make a special endoscopic evaluation of the larynx, trachea and bronchi. This can be augmented with endobronchial ultrasound (EBUS), which allows sonographic visualization of the tissue around the airway, most specifically the lymph nodes. EBUS is essential in diagnosing and staging tumors of the trachea, lungs and esophagus.
- Biopsy—Tumors of the airway or surrounding structures can be biopsied at the time of endoscopy or rarely at a separate appointment through the skin. Biopsy samples are evaluated under the microscope by pathologists on the medical staff, and rare cases are further reviewed at an interdisciplinary tumor board.
Opciones de tratamiento de la enfermedad traqueal
Las enfermedades y afecciones de la tráquea son complejas y requieren un enfoque multidisciplinario. Los cirujanos del personal médico del Departamento de Cirugía Torácica del Centro Médico de la Universidad de Baylor en Dallas coordinan la atención entre los cirujanos torácicos, neumólogos intervencionistas, cirujanos de cabeza y cuello, radiólogos, anestesiólogos y patólogos para determinar la estrategia óptima para cada paciente.
Los tratamientos para las enfermedades traqueales van desde la administración de medicamentos (como quimioterapia) o radiación, intervenciones endoscópicas o cirugía abierta. Los cirujanos torácicos se capacitan constantemente utilizando nuevos productos y técnicas para ofrecer la atención más avanzada en medicina traqueal y, a menudo, brindan terapia a pacientes que se consideran intratables en otros centros.
Opciones mínimamente invasivas
Las intervenciones con endoscopio se pueden realizar como tratamiento definitivo de muchas afecciones o para disminuir los síntomas. Por lo general, se pueden realizar a través de una pequeña cámara de fibra óptica (broncoscopio flexible), pero en ocasiones requieren un endoscopio metálico más grande (broncoscopio rígido); De cualquier manera, no se hacen incisiones y los efectos secundarios son mínimos. Estas intervenciones incluyen:
- Tumor removal—Some tumors can be partially or completely removed through a scope with no open surgery necessary. This can be done mechanically or with the aid of argon beam or laser therapy.
- Dilation—Tracheal stenosis or pressure by an external structure can be relieved by dilating the blocked area with a balloon, which can result in temporary or permanent resolution.
- Stents—Placement of metal or silicone stents within the area can keep the constricted area open. This can be performed as a temporary or permanent measure and allows for symptom relief while other treatments are administered, such as chemotherapy or radiation.
Surgery
La cirugía traqueal abierta es compleja y requiere de un centro quirúrgico especializado y un equipo altamente capacitado. Todos los cirujanos de Dallas dentro del Departamento de Cirugía Torácica del Centro Médico de la Universidad de Baylor están capacitados en cirugía avanzada de las vías respiratorias, que solo se realiza en centros selectos del país.
La cirugía de la tráquea implica la extirpación (resección) del segmento enfermo seguida de la reinserción de los extremos de las vías respiratorias (reconstrucción). Este es el método preferido para tratar enfermedades cancerosas, así como enfermedades benignas que no han respondido a técnicas menos invasivas. A veces es necesario realizar una traqueotomía temporal o permanente, una abertura creada quirúrgicamente en el cuello para respirar.
La resección y reconstrucción quirúrgica se realiza con mayor frecuencia a través de una incisión en el cuello, pero ocasionalmente requiere la extensión de la incisión hacia el tórax a través de una esternotomía o dividiendo la parte superior del esternón. Las enfermedades de las vías respiratorias inferiores, o bronquios, se pueden abordar a través del costado del tórax, dividiendo el músculo entre las costillas (toracotomía) y, en ocasiones, se puede realizar de forma mínimamente invasiva (cirugía torácica asistida por video, VATS).