Thoracic Surgical Unit, Massachusetts General Hospital, Boston, Massachusetts 02114, USA.
Semin Thorac Cardiovasc Surg. 2009 Fall;21(3):284-9. doi: 10.1053/j.semtcvs.2009.08.001.
Postintubation tracheal stenosis is caused by either cuff-induced ischemic damage to the trachea, stomal injury from a tracheostomy, or a combination of the two. Patients who present with stridor or unexplained dyspnea after a period of mechanical ventilation should be investigated for postintubation tracheal stenosis. Most patients with such an injury are candidates for tracheal resection and reconstruction. The length of the anticipated resection is the most important determinant of resectability. Tracheal resection is now a standardized operation with predictable, reliable, good results. The principles of operative repair include precise bronchoscopic assessment, complete tracheal mobilization, dissection close to the trachea to avoid recurrent nerve injury, and precise anastomotic technique.
气管插管后狭窄是由气管套囊引起的缺血性损伤、气管切开术引起的气管切开部位损伤，或两者共同引起的。在一段机械通气后出现喘鸣或不明原因呼吸困难的患者，应考虑气管插管后狭窄。大多数此类损伤的患者均为气管切除和重建的候选者。预计切除的长度是可切除性的最重要决定因素。气管切除现已成为一种标准化手术，具有可预测、可靠和良好的效果。手术修复的原则包括精确的支气管镜评估、彻底的气管游离、靠近气管进行解剖以避免喉返神经损伤，以及精确的吻合技术。
