Wright Cameron D, Grillo Hermes C, Wain John C, Wong Daniel R, Donahue Dean M, Gaissert Henning A, Mathisen Douglas J
Division of General Thoracic Surgery, Massachusetts General Hospital, Boston, MA 02114, USA.
J Thorac Cardiovasc Surg. 2004 Nov;128(5):731-9. doi: 10.1016/j.jtcvs.2004.07.005.
We sought to identify risk factors for anastomotic complications after tracheal resection and to describe the management of these patients.
This was a single-institution, retrospective review of 901 patients who underwent tracheal resection.
The indications for tracheal resection were postintubation tracheal stenosis in 589 patients, tumor in 208, idiopathic laryngotracheal stenosis in 83, and tracheoesophageal fistula in 21. Anastomotic complications occurred in 81 patients (9%). Eleven patients (1%) died after operation, 6 of anastomotic complications and 5 of other causes (odds ratio 13.0, P = .0001 for risk of death after anastomotic complication). At the end of treatment, 853 patients (95%) had a good result, whereas 37 patients (4%) had an airway maintained by tracheostomy or T-tube. The treatments of patients with an anastomotic complication were as follows: multiple dilations (n = 2), temporary tracheostomy (n = 7), temporary T-tube (n = 16), permanent tracheostomy (n = 14), permanent T-tube (n = 20), and reoperation (n = 16). Stepwise multivariable analysis revealed the following predictors of anastomotic complications: reoperation (odds ratio 3.03, 95% confidence interval 1.69-5.43, P = .002), diabetes (odds ratio 3.32, 95% confidence interval 1.76-6.26, P = .002), lengthy (> or =4 cm) resections (odds ratio 2.01, 95% confidence interval 1.21-3.35, P = .007), laryngotracheal resection (odds ratio 1.80, 95% confidence interval 1.07-3.01, P = .03), age 17 years or younger (odds ratio 2.26, 95% confidence interval 1.09-4.68, P = .03), and need for tracheostomy before operation (odds ratio 1.79, 95% confidence interval 1.03-3.14, P = .04).
Tracheal resection is usually successful and has a low mortality. Anastomotic complications are uncommon, and important risk factors are reoperation, diabetes, lengthy resections, laryngotracheal resections, young age (pediatric patients), and the need for tracheostomy before operation.
我们试图确定气管切除术后吻合口并发症的危险因素，并描述这些患者的治疗方法。
这是一项在单一机构进行的回顾性研究，纳入了901例行气管切除术的患者。
气管切除的适应证包括：插管后气管狭窄589例，肿瘤208例，特发性喉气管狭窄83例，气管食管瘘21例。81例患者（9%）发生了吻合口并发症。11例患者（1%）术后死亡，其中6例死于吻合口并发症，5例死于其他原因（吻合口并发症后死亡风险的比值比为13.0，P = 0.0001）。治疗结束时，853例患者（95%）预后良好，而37例患者（4%）需通过气管造口术或T形管维持气道。吻合口并发症患者的治疗方法如下：多次扩张（n = 2）、临时气管造口术（n = 7）、临时T形管（n = 16）、永久性气管造口术（n = 14）、永久性T形管（n = 20）和再次手术（n = 16）。逐步多变量分析显示吻合口并发症的以下预测因素：再次手术（比值比3.03，95%置信区间1.69 - 5.43，P = 0.002）、糖尿病（比值比3.32，95%置信区间1.76 - 6.26，P = 0.002）、长距离（≥4 cm）切除（比值比2.01，95%置信区间1.21 - 3.35，P = 0.007）、喉气管切除（比值比1.80，95%置信区间1.07 - 3.01，P = 0.03）、年龄17岁及以下（比值比2.26，95%置信区间1.09 - 4.68，P = 0.03）以及术前需要气管造口术（比值比1.79，95%置信区间1.03 - 3.14，P = 0.04）。
气管切除通常是成功的，死亡率较低。吻合口并发症并不常见，重要的危险因素包括再次手术、糖尿病、长距离切除、喉气管切除、年轻（儿科患者）以及术前需要气管造口术。
