{"id":18502,"date":"2020-01-27T10:57:37","date_gmt":"2020-01-27T09:57:37","guid":{"rendered":"https:\/\/devhml.givememore.net\/specialites\/chirurgie-thoracique\/chirurgie-de-laxe-tracheo-larynge\/"},"modified":"2022-02-10T15:52:21","modified_gmt":"2022-02-10T14:52:21","slug":"chirurgie-de-laxe-tracheo-larynge","status":"publish","type":"service","link":"https:\/\/devhml.givememore.net\/specialites\/chirurgie-thoracique\/interventions\/chirurgie-de-laxe-tracheo-larynge\/","title":{"rendered":"Chirurgie de l\u2019axe trach\u00e9o-laryng\u00e9"},"content":{"rendered":"\n<p class=\"wp-block-paragraph\"><strong>La pathologie trach\u00e9ale, qu\u2019il s\u2019agisse de st\u00e9noses post-intubation, de st\u00e9noses cong\u00e9nitales, de tumeurs primitives de la trach\u00e9e, de fistule \u0153so-trach\u00e9ale ou de l\u2019extension \u00e0 la bifurcation trach\u00e9obronchique de tumeur broncho-pulmonaire, est de traitement presque exclusivement chirurgical.<\/strong><\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Si la technique chirurgicale de r\u00e9section anastomose des st\u00e9noses et tumeurs de la trach\u00e9e, lorsqu\u2019elles sont peu \u00e9tendues, est devenue une technique de routine dans un service de chirurgie thoracique, un certain nombre d\u2019interventions rel\u00e8ve de centres d\u2019exception ; ce sont :<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les st\u00e9noses de la jonction laryngo-trach\u00e9ale qui n\u00e9cessitent une intervention dont les principes ont \u00e9t\u00e9 d\u00e9crits par Pearson \u00e0 Toronto et Grillo \u00e0 Boston. Cette chirurgie qui n\u2019est pas faite pas les oto-rhino-laryngologistes est r\u00e9alis\u00e9e dans les principaux centres de chirurgie thoracique dans le monde, que ce soit Toronto, Boston ou Marie Lannelongue. Apr\u00e8s avoir fait une soixantaine de r\u00e9sections laryngo-trach\u00e9ales type Pearson pour des st\u00e9noses, nous avons \u00e9tendu le concept de cette chirurgie aux tumeurs laryngotrach\u00e9ales notamment les cancers thyro\u00efdiens envahissant cette zone, aux fistules oesotrach\u00e9ales hautes de l\u2019adulte et aux st\u00e9noses laryngotrach\u00e9ales de l\u2019enfant avec d\u2019excellents r\u00e9sultats.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">La r\u00e9section-reconstruction de la bifurcation trach\u00e9o-bronchique est faite par peu de centres. Les r\u00e9sultats de cette chirurgie sont excellents dans la mesure o\u00f9 la mortalit\u00e9 postop\u00e9ratoire est de 7 % et que le taux actuel de survie \u00e0 5 ans des cancers sans envahissement ganglionnaire m\u00e9diastinal est de 53 %.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les tumeurs de la jonction cervico-m\u00e9diastinale, qu\u2019elles soient d\u2019origine laryng\u00e9e, \u0153sophagienne, thyro\u00efdienne ou trach\u00e9ale, surtout lorsqu\u2019il s\u2019agit de r\u00e9cidive apr\u00e8s plusieurs interventions chirurgicales compl\u00e9t\u00e9es par de la radioth\u00e9rapie, n\u00e9cessitent des exent\u00e9rations cervico-m\u00e9diastinales avec trach\u00e9ostomie m\u00e9diastinale des deux ou trois centim\u00e8tres de trach\u00e9e restante. Cette chirurgie faite dans notre service en collaboration avec les chirurgiens cervico-faciaux de l\u2019Institut Gustave Roussy, permet de traiter de telles tumeurs en termes curatifs et palliatifs ; ces patients \u00e9tant vou\u00e9s in\u00e9luctablement en l\u2019absence de telles interventions mutilantes, \u00e0 une mort par asphyxie ou h\u00e9morragie massive.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Un travail clinique et exp\u00e9rimental de reconstruction de trach\u00e9e par lambeaux libres fascio-cutan\u00e9s anti-brachiaux rigidifi\u00e9s par des cartilages costaux est en cours depuis 3 ans visant \u00e0 pouvoir disposer d\u2019un r\u00e9el substitut \u00e0 la trach\u00e9e lorsqu\u2019elle doit \u00eatre totalement remplac\u00e9e. Les premiers r\u00e9sultats ont \u00e9t\u00e9 pr\u00e9sent\u00e9s au 1er cours international de chirurgie laryngo-trach\u00e9ale \u00e0 Valence en avril 2008.<\/p>\n\n\n\n<p class=\"wp-block-paragraph\">Les compressions de la partie distale de la trach\u00e9e par des anomalies vasculaires aortiques cong\u00e9nitales telles que les crosses aortiques droites ou les diverticules de Kommerel \u00e9taient jusqu\u2019\u00e0 pr\u00e9sent de traitement al\u00e9atoire. Nous avons mis au point et publi\u00e9 en 2008 une nouvelle technique simple et originale de d\u00e9compression de la voie a\u00e9rienne, consistant \u00e0 allonger la crosse aortique.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>La pathologie trach\u00e9ale, qu\u2019il s\u2019agisse de st\u00e9noses post-intubation, de st\u00e9noses cong\u00e9nitales, de tumeurs primitives de la trach\u00e9e, de fistule \u0153so-trach\u00e9ale ou de l\u2019extension \u00e0 la bifurcation trach\u00e9obronchique de tumeur broncho-pulmonaire, est de traitement presque exclusivement chirurgical. Si la technique chirurgicale de r\u00e9section anastomose des st\u00e9noses et tumeurs de la trach\u00e9e, lorsqu\u2019elles sont peu \u00e9tendues, est [&hellip;]<\/p>\n","protected":false},"author":22,"featured_media":0,"parent":16234,"menu_order":3,"template":"","meta":{"_acf_changed":false,"advgb_blocks_editor_width":"","advgb_blocks_columns_visual_guide":"","site-sidebar-layout":"default","site-content-layout":"","ast-site-content-layout":"","site-content-style":"default","site-sidebar-style":"default","ast-global-header-display":"","ast-banner-title-visibility":"","ast-main-header-display":"","ast-hfb-above-header-display":"","ast-hfb-below-header-display":"","ast-hfb-mobile-header-display":"","site-post-title":"","ast-breadcrumbs-content":"","ast-featured-img":"","footer-sml-layout":"","theme-transparent-header-meta":"","adv-header-id-meta":"","stick-header-meta":"","header-above-stick-meta":"","header-main-stick-meta":"","header-below-stick-meta":"","astra-migrate-meta-layouts":"default","ast-page-background-enabled":"default","ast-page-background-meta":{"desktop":{"background-color":"var(--ast-global-color-4)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"ast-content-background-meta":{"desktop":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"tablet":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""},"mobile":{"background-color":"var(--ast-global-color-5)","background-image":"","background-repeat":"repeat","background-position":"center center","background-size":"auto","background-attachment":"scroll","background-type":"","background-media":"","overlay-type":"","overlay-color":"","overlay-opacity":"","overlay-gradient":""}},"footnotes":""},"etablissements":[],"services":[],"class_list":["post-18502","service","type-service","status-publish","hentry"],"acf":[],"featured_img":false,"coauthors":[],"author_meta":{"author_link":"https:\/\/devhml.givememore.net\/author\/charlotte-gmm\/","display_name":"Charlotte"},"relative_dates":{"created":"Publi\u00e9 6 ans il y a","modified":"Mis \u00e0 jour 4 ans il y a"},"absolute_dates":{"created":"Publi\u00e9 le 27 janvier 2020","modified":"Mise \u00e0 jour le 10 f\u00e9vrier 2022"},"absolute_dates_time":{"created":"Publi\u00e9 le 27 janvier 2020 10 h 57 min","modified":"Mise \u00e0 jour le 10 f\u00e9vrier 2022 15 h 52 min"},"featured_img_caption":"","tax_additional":{"etablissements":{"linked":[],"unlinked":[],"slug":"etablissements","name":"\u00c9tablissements"},"services":{"linked":[],"unlinked":[],"slug":"services","name":"Services"}},"series_order":"","_links":{"self":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/18502","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service"}],"about":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/types\/service"}],"version-history":[{"count":0,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/18502\/revisions"}],"up":[{"embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/service\/16234"}],"wp:attachment":[{"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/media?parent=18502"}],"wp:term":[{"taxonomy":"etablissements","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/etablissements?post=18502"},{"taxonomy":"services","embeddable":true,"href":"https:\/\/devhml.givememore.net\/api\/wp\/v2\/services?post=18502"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}