Department of Surgery, Section of General Thoracic Surgery, Emory University School of Medicine, Atlanta, Georgia 30322, USA.
Ann Thorac Surg. 2011 Apr;91(4):1101-6; discussion 1106. doi: 10.1016/j.athoracsur.2010.11.066.
Cervical tracheal stenosis can be a difficult condition to manage. Depending on the etiology, location, and extent of the stenosis, tracheal or cricotracheal resection may be required. Intraoperative decisions may predict outcome.
We performed a retrospective chart review of all patients undergoing cervical tracheal or cricotracheal resection from April 2000 through March 2008.
One hundred and five patients underwent 108 tracheal or cricotracheal resections. Median age was 65 years (range, 15 to 78); 68% were women. Indication for operation included postintubation tracheal stenosis (38), idiopathic (31), tracheostomy stenosis (19), invasive thyroid cancer (9), and other (8). Median length of trachea resected was 2.7 cm (range, 1.5 to 6.0 cm); 48 patients (46%) underwent extended cricotracheal resections. Twenty-six patients (25%) had an intraoperative chin stitch placed. Hospital stay was a median of 4 days (range, 2 to 33). Operative mortality was (1%); 1 patient died of myocardial infarction on postoperative day 3. Four patients (4%) had hoarseness or vocal cord immobility. Median follow-up was 36 months (range, 1 to 79). Eighteen patients (17%) required dilation postoperatively. Seven patients (7%) required tracheostomy; 2 (2%) are tracheostomy dependent. Three patients (3%) underwent a re-resection for recurrent stenosis. Multivariate analysis of indication for resection, type of resection, length of resection, anastomotic technique, and use of chin stitch did not predict the need for postoperative dilation, tracheostomy, or reoperation.
Cervical tracheal resection can be performed safely with low morbidity and mortality. Only 5% of patients required a long-term tracheostomy or re-resection for recurrent tracheal stenosis. Specific intraoperative decisions did not predict long-term success.
颈段气管狭窄的治疗较为棘手。根据病因、病变部位和狭窄范围，可能需要进行气管或环状软骨气管切除术。术中决策可能会影响手术结果。
我们对 2000 年 4 月至 2008 年 3 月期间所有接受颈段气管或环状软骨气管切除术的患者进行了回顾性病历分析。
105 例患者共接受了 108 次气管或环状软骨气管切除术。患者中位年龄为 65 岁（范围：1578 岁）；68%为女性。手术指征包括：气管插管后狭窄（38 例）、特发性（31 例）、气管切开术狭窄（19 例）、侵袭性甲状腺癌（9 例）和其他（8 例）。切除的气管中位长度为 2.7cm（范围：1.56.0cm）；48 例（46%）患者接受了环状软骨气管延长切除术。26 例（25%）患者术中行颏下缝线固定。中位住院时间为 4 天（范围：233 天）。手术死亡率为 1%（1 例患者术后第 3 天死于心肌梗死）。4 例（4%）患者出现声音嘶哑或声带运动障碍。中位随访时间为 36 个月（范围：179 个月）。术后 18 例（17%）患者需要扩张治疗。7 例（7%）患者需要行气管切开术；其中 2 例（2%）需要终身依赖气管切开术。3 例（3%）患者因复发性狭窄再次接受了切除术。对手术适应证、切除类型、切除长度、吻合技术和颏下缝线使用情况进行多因素分析，并未预测术后需要扩张、气管切开术或再次手术。
颈段气管切除术安全性高，发病率和死亡率低。仅 5%的患者需要长期行气管切开术或再次手术治疗复发性气管狭窄。特定的术中决策并不能预测长期效果。
