Göbel Gyula, Karaiskaki Niki, Gerlinger Imre, Mann Wolf J
Department of Otorhinolaryngology, Head and Neck Surgery, Johannes Gutenberg University, Mainz, Germany.
Laryngoscope. 2007 Oct;117(10):1741-4. doi: 10.1097/MLG.0b013e31811edd90.
Despite different support techniques, the surgical management of tracheomalacia is still a challenging problem. Satisfactory results after internal stenting are above 80%, whereas, when performing external stenting using biocompatible ceramic rings, results are reported at over 90%.
The purpose of this study was to examine the efficiency of surgical treatment in patients with segmentary tracheomalacia using external ceramic ring grafts.
In this retrospective study, we collected data from 12 patients who underwent surgery during the last 17 years for symptomatic segmentary tracheomalacia by use of biocompatible aluminum-oxide ceramic rings. All except one patient had undergone previous tracheostomy, six had a history of long-term intubation, two had previous trauma, and two patients had previous cancer treatment including radiotherapy. One of the patients still had an existing tracheostoma, which was closed when a ceramic ring was implanted. Tracheal wall collapse with pseudoglottis formation or flattened anterior-posterior tracheal diameter was documented with fiberoscopy at rest, and both pre- and postoperative airway resistance measurements were performed in all 12 patients using a spirometer. After malacic segments were found to be expandable using rigid tracheoscopy while the patient was under general anesthesia, preparation of the trachea was performed using a midline vertical incision in the neck. Subsequently, the malacic trachea was expanded by placing and suturing proper-sized ceramic ring(s) around it.
In all patients, surgical expansion of the malacic segment using ceramic rings was successfully carried out without major complications while inspiratory stridor was resolved. Airway resistance decreased significantly from an average of 0.62 to 0.385 kPascal.
Although the results of applying internal tracheal stents are encouraging, complications such as stent migration, granulation tissue and fistula formation, and mucociliary transport arrest are possible. Biocompatible ceramic rings do not cause foreign body reactions, remain stabile, and, with a proper suturing technique, provide a suitable long-term solution.
尽管有不同的支撑技术，但气管软化症的外科治疗仍然是一个具有挑战性的问题。内部支架置入术后的满意结果超过80%，而使用生物相容性陶瓷环进行外部支架置入时，报告的结果超过90%。
本研究的目的是探讨使用外部陶瓷环移植治疗节段性气管软化症患者的手术疗效。
在这项回顾性研究中，我们收集了过去17年中12例因症状性节段性气管软化症接受手术治疗患者的数据，这些患者使用了生物相容性氧化铝陶瓷环。除1例患者外，所有患者均曾行气管切开术，6例有长期插管史，2例有既往外伤史，2例有既往癌症治疗史，包括放疗。其中1例患者仍有气管造口，在植入陶瓷环时将其封闭。通过纤维喉镜检查记录静息时气管壁塌陷伴假声门形成或气管前后径变平的情况，并使用肺活量计对所有12例患者进行术前和术后气道阻力测量。在全身麻醉下使用硬支气管镜检查发现软化节段可扩张后，采用颈部正中垂直切口对气管进行准备。随后，通过在软化气管周围放置并缝合合适尺寸的陶瓷环来扩张软化气管。
在所有患者中，使用陶瓷环成功地对软化节段进行了手术扩张，未出现重大并发症，同时吸气性喘鸣得到缓解。气道阻力从平均0.62千帕显著降至0.385千帕。
尽管应用气管内支架的结果令人鼓舞，但仍可能出现支架移位、肉芽组织和瘘管形成以及黏液纤毛运输停滞等并发症。生物相容性陶瓷环不会引起异物反应，保持稳定，并且通过适当的缝合技术可提供合适的长期解决方案。
