Tsugawa C, Nishijima E, Muraji T, Matsumoto Y, Yamaguchi M, Murata H, Kimura K
Department of Surgery, Kobe Children's Hospital, Japan.
J Pediatr Surg. 1991 Jul;26(7):762-5. doi: 10.1016/0022-3468(91)90133-e.
For the surgical repair of long-segment tracheal stenosis, costal cartilage graft or extensive resection with end-to-end anastomosis has often been used. Both procedures have a risk of developing anastomotic leakage, which is potentially a lethal complication, or stenosis resulting from compromised blood supply to the tissue at the anastomosis. We have used omental pedicle flap (OPF) to seal the anastomotic line and to restore the vascularity of the graft and the trachea in an attempt to avoid fatal complications. During the period between 1986 and 1990, OPF technique was used in tracheobronchial reconstruction in six patients aged 4 months to 3 years; cartilage graft for extensive tracheal stenosis (4), tracheal resection and anastomosis (1), and bronchial resection and anastomosis (1). The omentum was separated from the colon to form an OPF with the right gastroepiploic vessels preserved. The OPF was brought to the upper trachea in the mediastinum through the retrosternal space. There was no immediate postoperative death due to anastomotic leak. Endotrachial tubes were removed in all patients. Four of the six are totally free of airway problems. One patient showed persistent stridor because of remaining stenosis at the cervical trachea. The remaining one patient who underwent bronchial resection developed anastomotic stenosis probably due to the compression of the floppy left main bronchus by adjacent aorta. The OPF seems to be an important surgical adjunct in order to eliminate fatal complications in tracheobronchial reconstruction.
对于长段气管狭窄的手术修复，常采用肋软骨移植或广泛切除并端端吻合术。这两种手术都有发生吻合口漏的风险，这可能是一种致命的并发症，或者因吻合口组织血供受损导致狭窄。我们使用带蒂大网膜瓣（OPF）来封闭吻合线并恢复移植组织和气管的血供，以避免致命并发症。在1986年至1990年期间，OPF技术用于6例年龄在4个月至3岁的患者的气管支气管重建；4例用于广泛气管狭窄的软骨移植，1例用于气管切除并吻合，1例用于支气管切除并吻合。将大网膜从结肠分离，形成保留右胃网膜血管的带蒂大网膜瓣。带蒂大网膜瓣通过胸骨后间隙带到纵隔内的上段气管。术后没有因吻合口漏立即死亡的情况。所有患者均拔除了气管内插管。6例中有4例完全没有气道问题。1例患者因颈段气管残留狭窄而持续有喘鸣。其余1例接受支气管切除的患者发生了吻合口狭窄，可能是由于邻近的主动脉对松软的左主支气管的压迫所致。带蒂大网膜瓣似乎是消除气管支气管重建中致命并发症的一种重要手术辅助手段。
