Schröder Carsten, Scholl Frank, Daon Emmanuel, Goodwin Andrea, Frist William H, Roberts John R, Christian Karla G, Ninan Mathew, Milstone Aaron P, Loyd James E, Merrill Walter H, Pierson Richard N
Department of Cardiac and Thoracic Surgery, Vanderbilt University, Nashville, Tennessee, USA.
Ann Thorac Surg. 2003 Jun;75(6):1697-704. doi: 10.1016/s0003-4975(03)00011-0.
Low rates of major complications have been reported for the intussuscepting bronchial anastomotic technique but stenosis, malacia, and granulation tissue at the anastomosis may cause clinically important morbidity. We hypothesized that a modification of the telescoping technique that improves bronchial wall apposition might be associated with improved bronchial healing and clinical outcomes.
The telescoping horizontal mattress "U-stitch" suture technique was modified to incorporate figure-of-eight sutures placed in the cartilaginous wall between each of three intussuscepting U stitches. Serial videotape records of 152 individual anastomoses (99 modified, 53 telescoped) in 118 consecutive operative survivors were retrospectively reviewed by examiners blinded with respect to technique used. Stenosis, airway instability, mucosa quality, and devascularized luminal tissue were graded at 4 to 14 days (initial), 4 to 12 weeks (early), and 6 to 12 months (late) after transplantation.
The incidence of anastomotic stenosis was significantly lower using the modified technique at the initial (p = 0.025) and late (p = 0.015) observations. In the initial phase airway instability (p = 0.015) and devascularization grades (p = 0.001) were also significant lower in the modified group. There were no significant differences in mucosal condition between techniques. The modified telescoping technique was associated with significant survival advantage (mean 17.7%; p = 0.029) by multivariate analysis. The incidence of major airway complications (dehiscences and stenoses required stents) tended to be lower (3% versus 6%) in the modified group.
The modified telescoping bronchial anastomosis technique is associated with improved early and late bronchial healing and higher 5-year survival without increased major airway complications.
已有报道称套叠式支气管吻合技术的主要并发症发生率较低，但吻合口处的狭窄、软化和肉芽组织可能导致具有临床意义的发病情况。我们推测，对套叠技术进行改良以改善支气管壁贴合，可能会改善支气管愈合及临床结局。
对套叠式水平褥式“U形缝合”技术进行改良，在三个套叠的U形缝合线之间的软骨壁上加入8字缝合线。由对所使用技术不知情的检查人员对118例连续手术存活者的152例个体吻合术（99例改良，53例套叠）的系列录像记录进行回顾性审查。在移植后4至14天（初期）、4至12周（早期）和6至12个月（晚期）对狭窄、气道稳定性、黏膜质量和缺血性管腔组织进行分级。
在初期（p = 0.025）和晚期（p = 0.015）观察中，改良技术的吻合口狭窄发生率显著更低。在初期阶段，改良组的气道不稳定性（p = 0.015）和缺血分级（p = 0.001）也显著更低。两种技术在黏膜状况方面无显著差异。多因素分析显示，改良套叠技术具有显著的生存优势（平均17.7%；p = 0.029）。改良组的主要气道并发症（裂开和狭窄需要置入支架）发生率往往更低（3%对6%）。
改良的套叠式支气管吻合技术与改善早期和晚期支气管愈合以及提高5年生存率相关，且未增加主要气道并发症。
