Division of Head and Neck Surgery, Department of Surgery, University of Hong Kong Li Ka Shing Faculty of Medicine, Queen Mary Hospital, Hong Kong, China.
Laryngoscope. 2011 Jul;121(7):1441-5. doi: 10.1002/lary.21852. Epub 2011 May 18.
OBJECTIVES/HYPOTHESIS: To review our experience with manubrial resection and anterior mediastinal tracheostomy and formulate operative guidelines to improve the surgical outcome.
Retrospective study.
Between January 1980 and June 2010, we performed 38 manubrial resections. The indications of the procedure, reconstructive methods, and operative outcomes were analyzed.
Fourteen patients had tumors of the hypopharynx/cervical esophagus, eight had parastomal recurrences of laryngeal tumor, four had recurrent esophageal tumors, four had postirradiation sarcoma, four suffered from subglottic/upper tracheal tumors, three had thyroid malignancy, and the remaining patient had tumor recurrence at the previous tracheostomy site. The hospital mortality rate was 5.3% due to bleeding from major vessel erosion. The mean length of the tracheal stump was 5.4 cm, of which 81.6% required relocation inferior to the innominate artery for construction of the mediastinal tracheostomy. Among the different reconstructive methods for the pharyngoesophageal defects, the anastomotic leakage rate was 17.6%, the majority of which required exteriorization followed by second stage reconstruction. The long-term tracheostomy stenosis rate was 47.4%, the risk of which was significantly increased by anastomotic leakage and necrosis of distal trachea. The use of a pectoralis major flap was shown to protect against this complication. The overall survival was 80.6% at 1 year and 55.6% at 5 years after surgery.
With attention to operative details, manubrial resection and anterior mediastinal tracheostomy is a safe procedure with acceptable outcome. It should be performed when indicated to facilitate tumor resection in the cervicothoracic region.
目的/假设：回顾我们在胸骨切除和前纵隔气管造口术方面的经验，并制定手术指南以改善手术结果。
回顾性研究。
1980 年 1 月至 2010 年 6 月期间，我们进行了 38 例胸骨切除术。分析了该手术的适应证、重建方法和手术结果。
14 例患者为下咽/颈段食管肿瘤，8 例为喉肿瘤的吻合口复发，4 例为复发性食管肿瘤，4 例为放疗后肉瘤，4 例为声门下/上气管肿瘤，3 例为甲状腺恶性肿瘤，其余患者为先前气管造口部位肿瘤复发。因大血管侵蚀出血导致院内死亡率为 5.3%。气管残端的平均长度为 5.4cm，其中 81.6%需要向下移位至无名动脉以构建纵隔气管造口术。在咽食管缺损的不同重建方法中，吻合口漏的发生率为 17.6%，其中大多数需要外置，然后进行二期重建。长期气管造口狭窄的发生率为 47.4%，吻合口漏和远端气管坏死会显著增加这种风险。使用胸大肌皮瓣可预防这种并发症。手术后 1 年和 5 年的总体生存率分别为 80.6%和 55.6%。
如果操作细节得当，胸骨切除和前纵隔气管造口术是一种安全的手术，具有可接受的效果。当需要在颈胸区域进行肿瘤切除时，应进行该手术。
