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110例气管切除术后的长期结果

Long-term results after 110 tracheal resections.

作者信息

Friedel Godehard, Kyriss Thomas, Leitenberger Andrea, Toomes Heikki

机构信息

Department of Thoracic Surgery, Schillerhoehe Hospital, Centre for Pneumology and Thoracic Surgery, Gerlingen, Germany.

出版信息

Ger Med Sci. 2003 Dec 18;1:Doc10.

PMID:19675708
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC2703230/
Abstract

OBJECTIVE

Among the many therapeutic options for treating tracheal stenosis (e.g. bouginage, laser resection and stenting), segmental resection and reconstruction with end-to-end anastomosis is the method of choice. We verified this in an analysis of clinical material.

PATIENTS AND METHODS

We retrospectively evaluated 110 tracheal sleeve resections performed between 1985 and 2001. Data before and after resection were analyzed, and the patients were interviewed.

RESULTS

The aetiology of stenosis was mainly postintubation injury (n = 92) (83.6%), followed by goiter with malacia (n = 8) (7.3%) and tumor (n = 6) (5.5%). There were a few other causes (n = 3) (2.7%). 48 patients (43.6%) had undergone prior conservative or surgical treatment other than sleeve resection. A cervical approach was used in 93 (84.6%), a cervicomediastinal in 15 (13.6%), and a transthoracic in two. Healing of anastomosis was uncomplicated in 101 patients (91.8%). Major and minor complications occurred in 29 patients (26.4); there were 4 dehiscences (3.6%), 3 restenoses (2.7%), 2 suture line granulations (1.8%) and 4 vocal cord dysfunctions (3.6%). The 30-day mortality rate was 0.9%. 77 patients were interviewed after surgery (median 80.1 months); 93.5% (n = 72) were satisfied with the surgical treatment.

CONCLUSIONS

Resection and reconstruction offer the best treatment for tracheal stenosis. Lethal complications were due to severe comorbidity. Many patients today still undergo unsuccessful conservative treatment before being referred to surgery.

摘要

目的

在治疗气管狭窄的众多治疗选择中（例如探条扩张术、激光切除术和支架置入术），节段性切除并端端吻合重建术是首选方法。我们通过对临床资料的分析验证了这一点。

患者与方法

我们回顾性评估了1985年至2001年间进行的110例气管袖状切除术。分析了切除前后的数据，并对患者进行了访谈。

结果

狭窄的病因主要是插管后损伤（n = 92）（83.6%），其次是伴有软化的甲状腺肿（n = 8）（7.3%）和肿瘤（n = 6）（5.5%）。还有一些其他原因（n = 3）（2.7%）。48例患者（43.6%）在接受袖状切除术之前曾接受过其他保守或手术治疗。93例（84.6%）采用颈部入路，15例（13.6%）采用颈纵隔入路，2例采用经胸入路。101例患者（91.8%）吻合口愈合顺利。29例患者（26.4%）发生了严重和轻微并发症；有4例吻合口裂开（3.6%），3例再狭窄（2.7%），2例缝线处肉芽组织增生（1.8%）和4例声带功能障碍（3.6%）。30天死亡率为0.9%。术后对77例患者进行了访谈（中位时间80.1个月）；93.5%（n = 72）对手术治疗满意。

结论

切除重建术为气管狭窄提供了最佳治疗方法。致命并发症是由严重的合并症引起的。如今，许多患者在转诊至手术治疗前仍接受了不成功的保守治疗。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/44a7c46d5250/GMS-01-10-g-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/5475cec26520/GMS-01-10-t-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/c3caf5eccfdd/GMS-01-10-t-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/36f26b73f485/GMS-01-10-t-003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/7a4411c133a4/GMS-01-10-t-004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/9cabc8f75ff8/GMS-01-10-t-005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/052d7c165c0d/GMS-01-10-t-006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/fbcd5e621ffe/GMS-01-10-g-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/44a7c46d5250/GMS-01-10-g-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/5475cec26520/GMS-01-10-t-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/c3caf5eccfdd/GMS-01-10-t-002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/36f26b73f485/GMS-01-10-t-003.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/7a4411c133a4/GMS-01-10-t-004.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/9cabc8f75ff8/GMS-01-10-t-005.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/052d7c165c0d/GMS-01-10-t-006.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/fbcd5e621ffe/GMS-01-10-g-001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/7da6/2703230/44a7c46d5250/GMS-01-10-g-002.jpg

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A Novel Surgical Technique for Thyroid Cancer with Intra-Cricotracheal Invasion: Windmill Resection and Tetris Reconstruction.一种用于治疗伴有气管内侵犯的甲状腺癌的新型手术技术：风车切除术与俄罗斯方块重建术。
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