Idiopathische subglottische Tracheastenose

Zusammenfassung

Die idiopathische subglottische Stenose ist eine zirkuläre narbige Einengung des Atemweges am Übergang vom Ringknorpel auf die Trachea. Die Stenose befindet sich radiologisch und endoskopisch im Niveau des Ringknorpels ohne Beteiligung des Ring- oder Tracheaknorpels selbst. Die Erkrankung befällt praktisch nur Frauen zwischen dem 20. und 60. Lebensjahr. Dasselbe Krankheitsbild tritt bei der Granulomatose mit Polyangiitis und seltener bei anderen Autoimmunerkrankungen auf und erfordert dort eine systemische Behandlung. Die Klinik beginnt i. d. R. schleichend mit Husten und Auswurf und führt im Verlauf zu Dyspnoe und zu einem eingeschränkten Hustenstoß. Da der Verlauf schleichend ist und die Patientinnen sonst gesund sind, werden die Beschwerden oft fehlgedeutet und die Diagnose wird verzögert. Die Behandlung besteht in lokalen Maßnahmen von der Dilatation über die laserchirurgische Resektion, z. T. mit lokaler Applikation von Medikamenten, die eine Proliferation von neuem Narbengewebe hemmen sollen, bis zur laryngotrachealen Resektion verschiedenen Ausmaßes. Die Erkrankung liegt im Grenzgebiet zwischen Trachea und Larynx und die Patienten und Patientinnen werden deshalb von der HNO-Heilkunde, der Pneumologie und der Thoraxchirurgie betreut.

Abstract

Idiopathic subglottic stenosis is a circular scarred narrowing of the airway at the transition from the cricoid cartilage to the trachea. The stenosis is found radiologically and endoscopically at the level of the cricoid cartilage without involvement of the cricoid or tracheal cartilage itself. The disease practically only affects women between the ages of 20 and 60. The same clinical picture occurs in granulomatosis with polyangiitis and less frequently in other autoimmune diseases, where it requires systemic treatment. The clinical picture usually begins insidiously with coughing and sputum production and leads to dyspnoea and a restricted cough. As the course is insidious and the patients are otherwise healthy, the symptoms are often misinterpreted and the diagnosis is delayed. Treatment consists of local measures, ranging from dilatation and laser surgical resection, sometimes with local application of medication to inhibit the proliferation of new scar tissue, to laryngotracheal resection of varying degrees. The disease is located in the border area between the trachea and larynx and the patients are therefore treated by ENT medicine, pneumology and thoracic surgery.

Schlüsselwörter

Trachea - idiopathische subglottische Tracheastenose - Thoraxchirurgie

Keywords

trachea - idiopathic subglottic tracheal stenosis - thoracic surgery

Publication History

Received: 20 November 2023

Accepted after revision: 17 December 2023

Article published online:
15 February 2024

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