Amorós Juan Moya, Ramos Ricard, Villalonga Rosa, Morera Ricard, Ferrer Gerardo, Díaz Pablo
Department of Thoracic Surgery, Hospital Universitari de Bellvitge, L'Hospitalet del Llobregat, Barcelona, Spain.
Eur J Cardiothorac Surg. 2006 Jan;29(1):35-9. doi: 10.1016/j.ejcts.2005.10.023. Epub 2005 Dec 6.
Partial tracheal resection (Küster operation (KO)) and cricotracheal resection (Pearson operation (PO)) are currently the standard operative techniques in the curative treatment of tracheal and cricotracheal stenosis, respectively. This study aims to analyze the outcomes of tracheal and cricotracheal resection when a specific protocol is applied.
Between 1990 and 2004 we treated 54 patients with laryngotracheal stenosis. The mean age was 44.9 years with a sex ratio of 1:1. All patients were treated according to the random protocol "Lesions of the main airway (MA) protocol," which considers the following stenosis variables: stage of development (S), caliber (C), and length (L). We performed 38 Küster operations, 14 Pearson operations, and 2 combined Pearson-Küster-Rethi operations (ROs).
Overall mortality of the series was 1.85%, with a specific morbidity of 27.7%. A total of 96.2% of patients were cured (85.6% of Pearson operation and 100% of Küster operation). We performed 3.7% re-interventions (14.2% of Pearson operation and 0% of Küster operation), and the failure rate was 3.7% (14.4% of Pearson operation and 0% of Küster operation). We had 27.5% who had postoperative complications (28.5% of Pearson operation and 26.3% of Küster operation). The most frequent complications were restenosis (14.2%), granulation tissue (13.1%), edema (10.5%), anastomotic dehiscence (7.1%), and tracheoesophageal fistula (7.1%). In terms of the SCL variables, significant differences were only observed with respect to morbidity between the S4 group and the other cases without tracheoesophageal fistula in the Küster operation group; we found no differences in Pearson operation.
Application of the Main Airway protocol allowed development of a strategy for the surgical treatment of main airway stenosis. This, in turn, enabled a strict selection of cases and meticulous preoperative preparation that, coupled with a highly effective surgical technique, led to excellent outcomes with minimal sequel. The presence of tracheoesophageal fistula could increase the complications.
部分气管切除术（屈斯特手术（KO））和环状气管切除术（皮尔逊手术（PO））目前分别是气管和环状气管狭窄根治性治疗的标准手术技术。本研究旨在分析应用特定方案时气管和环状气管切除术的结果。
1990年至2004年间，我们治疗了54例喉气管狭窄患者。平均年龄为44.9岁，男女比例为1:1。所有患者均按照“主气道病变（MA）方案”这一随机方案进行治疗，该方案考虑以下狭窄变量：发育阶段（S）、管径（C）和长度（L）。我们进行了38例屈斯特手术、14例皮尔逊手术和2例皮尔逊 - 屈斯特 - 雷蒂联合手术（RO）。
该系列的总体死亡率为1.85%，特定发病率为27.7%。共有96.2%的患者治愈（皮尔逊手术为85.6%，屈斯特手术为100%）。我们进行了3.7%的再次干预（皮尔逊手术为14.2%，屈斯特手术为0%），失败率为3.7%（皮尔逊手术为14.4%，屈斯特手术为0%）。我们有27.5%的患者出现术后并发症（皮尔逊手术为28.5%，屈斯特手术为26.3%）。最常见的并发症是再狭窄（14.2%）、肉芽组织（13.1%）、水肿（10.5%）、吻合口裂开（7.1%）和气管食管瘘（7.1%）。就SCL变量而言，仅在屈斯特手术组的S4组与其他无气管食管瘘的病例之间观察到发病率存在显著差异；在皮尔逊手术中未发现差异。
应用主气道方案有助于制定主气道狭窄的手术治疗策略。这反过来又能够严格选择病例并进行细致的术前准备，再加上高效的手术技术，从而以最小的后遗症获得优异的治疗效果。气管食管瘘的存在可能会增加并发症。
