Division of Thoracic Surgery and Interventional Pulmonology, Beth Israel Deaconess Medical Center, Department of Surgery, Harvard Medical School, Boston, Massachusetts 02215, USA.
Ann Thorac Surg. 2011 May;91(5):1574-80; discussion 1580-1. doi: 10.1016/j.athoracsur.2011.01.009. Epub 2011 Mar 5.
Tracheobronchomalacia is an underrecognized cause of dyspnea, recurrent respiratory infections, and cough. Surgical stabilization with posterior membranous tracheobronchoplasty has been shown to be effective in selected patients with severe disease. This study examines the technical details and complications of this operation.
A prospectively maintained database of tracheobronchomalacia patients was queried retrospectively to review all consecutive tracheobronchoplasties performed from October 2002 to June 2009. Posterior splinting was performed with polypropylene mesh. Patient demographics, surgical outcomes, and operative data were reviewed.
Sixty-three patients underwent surgical correction of tracheal and bilateral bronchial malacia. Twenty-three patients had chronic obstructive pulmonary disease, 18 had asthma, 5 had Mounier-Kuhn syndrome, and 4 had interstitial lung disease. Seven patients had a previous tracheotomy. Operative time was 373 ± 93 minutes. Median length of stay was 8 days (range, 4 to 92 days), of which 3 days (range, 0 to 91 days) were in intensive care. Seventy-five percent of patients were discharged home (28% with visiting nurse follow-up), and 25% went to a rehabilitation facility. Two patients (3.2%) died postoperatively-1 of worsening usual interstitial pneumonia, and the other of massive pulmonary embolism. Complications included a new respiratory infection in 14 patients, pulmonary embolism in 2, and atrial fibrillation in 6. Six patients required reintubation, and 9 received a postoperative tracheotomy; 47 patients required postoperative aspiration bronchoscopy.
In experienced hands, tracheobronchoplasty can be performed with a very low mortality rate and an acceptable perioperative complications rate in patients with significant pulmonary comorbidity. Intervention for postoperative respiratory morbidity is often necessary.
气管支气管软化是呼吸困难、反复呼吸道感染和咳嗽的一个未被充分认识的原因。在有严重疾病的选定患者中，后路膜性气管支气管成形术的外科稳定已被证明是有效的。本研究检查了该手术的技术细节和并发症。
通过回顾性查询前瞻性维护的气管支气管软化患者数据库，回顾了 2002 年 10 月至 2009 年 6 月期间连续进行的所有气管支气管成形术。采用聚丙烯网片进行后向支撑。患者的人口统计学资料、手术结果和手术数据均进行了回顾。
63 例患者接受了气管和双侧支气管软化的手术矫正。23 例患者患有慢性阻塞性肺疾病，18 例患者患有哮喘，5 例患者患有 Mounier-Kuhn 综合征，4 例患者患有间质性肺病。7 例患者曾行气管切开术。手术时间为 373 ± 93 分钟。中位住院时间为 8 天（范围为 4 至 92 天），其中 3 天（范围为 0 至 91 天）在重症监护病房。75%的患者出院回家（28%接受家庭访视护士随访），25%去康复机构。2 例患者（3.2%）术后死亡-1 例为间质性肺炎恶化，另 1 例为肺栓塞。并发症包括 14 例新发呼吸道感染、2 例肺栓塞和 6 例心房颤动。6 例患者需要重新插管，9 例患者接受术后气管切开术；47 例患者需要术后经支气管镜吸痰。
在有经验的医生手中，气管支气管成形术可以在有严重肺部合并症的患者中以非常低的死亡率和可接受的围手术期并发症发生率进行。术后呼吸系统并发症的干预通常是必要的。
