Donahue Dean M
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, USA.
Chest Surg Clin N Am. 2003 May;13(2):375-83. doi: 10.1016/s1052-3359(03)00028-0.
Tracheal resection and reconstruction for postintubation stenosis is successful in more than 95% of initial repair attempts. The most likely causes of anastomotic failure are anastomotic tension, local devascularization, and granulomatous foreign body reaction. Incomplete resection of areas of stenosis or malacia might also lead to postoperative airway compromise. A variety of systemic factors might contribute to poor anastomotic healing. Postoperative respiratory difficulty requires immediate evaluation. In a patient with recurrent tracheal stenosis, the airway can be managed with dilation, or a tracheostomy or T-tube can be inserted through the failed anastomosis. Patients who are candidates for reoperative tracheal resection and reconstruction can expect good or satisfactory results in 91.9% of cases. Preoperatively addressing the patient's risk factors for failing, and liberally employing release procedures to reduce tension on the anastomosis contribute to the success of a reoperative procedure.
气管插管后狭窄的气管切除与重建手术，在超过95%的初次修复尝试中取得成功。吻合失败最可能的原因是吻合口张力、局部血运障碍以及肉芽肿性异物反应。狭窄或软化区域切除不完全也可能导致术后气道受损。多种全身因素可能导致吻合口愈合不良。术后呼吸困难需要立即评估。对于复发性气管狭窄患者，气道可通过扩张处理，也可经失败的吻合口插入气管造口或T形管。再次进行气管切除与重建手术的患者，91.9%的病例可获得良好或满意的结果。术前处理患者失败的风险因素，并充分采用松解手术以减轻吻合口的张力，有助于再次手术的成功。
