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The data on diagnosis and treatment of 200 patients with acute postintubation laryngostenosis (LS) and tracheostenosis (TS) are reviewed. Peculiarities of tracheostomy technique practiced in critical care units are specified. Postintubation and posttracheostomy alterations in the larynx and trachea detected endoscopically are described. Effective endosurgical methods are proposed to avoid multistage surgical rehabilitation for recovery of the respiration function in 97% LS and TS patients.

The authors present 10-year experience gained in the treatment of 450 patients subjected to intubation, artificial lung ventilation, tracheostomy in critical care units. Updated approaches to the diagnosis, treatment and prevention in the above patients, classification of postintubation stenoses of the larynx and trachea allowed to raise rehabilitation effectiveness to 95 and 78% in patients with early (within 3 months after intubation) and late (more than 3 months after intubation) stenosis, respectively.

Experience gained in the diagnosis and treatment of 498 patients with postintubation laryngotracheal stenosis is summarized. Use of accessory methods of diagnosis, such as x-ray tomography of the trachea and mediastinum and endofibroscopy of the larynx and trachea is validated. Flexible endoscopes with kits of special instruments allow decannulation without subsequent therapy in 95% patients. Simultaneous tracheoplasty and retracheostomy simplify surgical treatment of patients with postintubation laryngotracheal stenosis, making it shorter by 1-2 stages. The development of laryngotracheal stenoses depends on the duration of intubation, and hence, the optimal term for tracheostomy in patients on forced ventilation of the lungs is day 3 after intubation.

The paper provides results of examinations and surgical treatment in 190 patients with laryngeal and tracheal stenosis of different origin. The most favourable results were obtained in patients with postresuscitation stenosis, middle paralysis, posttraumatic stenosis: up to 75%, 71% and 55% of the responders, respectively. The canule remains for life in 20% of the surgical patients, because they have severe laryngeal and tracheal deformities associated with other affections.

Forty-eight patients with laryngeal, tracheal, and esophageal stenoses were treated making use of flexible endoscopes of various diameters and a kit of special instruments. Indications for endoscopic treatment were the presence of an 'overhang' along the upper edge of tracheostoma, laryngeal and tracheal granulation, cicatricial strictures of the esophagus with a lumen of less than 5 mm in diameter. Use of flexible endoscopes with a kit of special instruments helped do without many-staged surgical treatment in 20% of patients with chronic stenoses of hollow organs of the neck.

The experience of management of 123 patients after tracheostomy and the following prolonged controlled lung ventilation has been summarized. The techniques of tracheostomy and postoperative management that made it possible to decanulate 118 patients without additional surgical interventions have been described. The studies performed using radiopharmacological agents have revealed considerable disturbances of the pulmonary flow, foci of chronic inflammation in tracheal and bronchial cartilages, mediastinal lymph nodes and pulmonary tissue, reduction in pulmonary tissue elasticity and increase of the lung area.

The ECG signal was studied by the method of Simson in 43 patients with the clinical pattern of respiratory failure of different genesis with the aim in view to detect signs of late ventricular potentials (LVP) in the QRS vector and in separate orthogonal leads X, Y and Z. The signal was averaged by 150 complexes. It has been shown that 53% of the patients examined have signs of LVP, their incidence being much higher in critical patients subjected to controlled lung ventilation. Characteristic differences of the LVP signs analysed in leads X, Y and Z have been detected, as compared to the analogous parameters of the control group.

Altogether 19 patients with chronic laryngo- and tracheostenosis of different etiology were investigated. All the patients were broken into 3 groups (1--less than 1 year, 2-1-3 years, 3--over 3 years) with regard to the time of canulla bearing. The patients were examined with 99mTc-human serum albumin particles. Major disorders in the capillary blood supply of both lungs were detected. These changes were focal-diffuse. Abnormalities were mainly observed in the apical area of both lungs and in the mediastinal zone. Redistribution of the pulmonary blood supply in the direction of the upper parts of the lungs was revealed. Lung abnormalities increased depending on the time of canulla bearing.

In 160 patients, postoperative healing of stenoses of hollow neck organs of various etiology was examined clinically and morphologically. All the patients were divided into 4 groups in terms of the etiological factor as follows: Group 1 (60 patients)--patients with post-traumatic stenoses of the larynx and trachea; Group 2 (34 patients)--patients with post-resuscitation stenoses of the larynx and trachea; Group 3 (38 patients)--patients with bilateral laryngoparalysis that developed after strumectomy; Group 4 (28 patients)--patients with postburn deformation of the pharyngolarynx and esophagus. Pathomorphological changes typical of a chronic inflammatory process were detected in the frontal neck tissues (skin, muscles, cartilages, mucous membrane) of all the patients. Morphologically, the frontal neck tissues were similar in all the patients. In view of this, a large number of suppurative-necrotic complications seen after surgery of stenoses of hollow neck organs (up to 45%) can be attributed to pathological lesions in the frontal neck tissues.