Division of Thoracic Surgery and Interventional Pulmonology, Boston, MA.
Section of Otology and Laryngology, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA.
Chest. 2015 Oct;148(4):e106-e108. doi: 10.1378/chest.15-0240.
A 68-year-old man with recurrent medullary thyroid cancer underwent cervical tracheal resection and reconstruction. His course was complicated by tracheal anastomotic dehiscence, right carotid blowout, and ultimately cervical tracheoplasty with AlloDerm. Given the complex vascular interventions and upper-airway anatomy, a custom-designed Montgomery T-tube was designed for him. Three-dimensional digital reconstruction of his upper airways was obtained from a CT scan. The T-tube was designed and fabricated based on the digital trachea model and was subsequently placed successfully. Follow-up CT scan and bronchoscopy confirmed placement and revealed no granulation tissue at 4 weeks. The patient was discharged to home with the ability to phonate. To our knowledge, this is the first demonstration of three-dimensional modeling of an upper-airway defect with subsequent T-tube design using engineering software. The success of this case demonstrates a possible avenue for personalized airway prosthesis design and manufacturing in the future.
一位 68 岁的复发性甲状腺髓样癌患者接受了颈部气管切除术和重建术。他的病程复杂，包括气管吻合口裂开、右侧颈动脉破裂，最终采用 AlloDerm 进行了颈气管成形术。鉴于复杂的血管介入和上呼吸道解剖结构，为他设计了一种定制的 Montgomery T 型管。通过 CT 扫描获得了他上呼吸道的三维数字重建。根据数字气管模型设计和制造了 T 型管，并随后成功放置。4 周时的 CT 扫描和支气管镜检查证实了位置，且没有肉芽组织。患者能够发声并出院回家。据我们所知，这是首次使用工程软件对上呼吸道缺陷进行三维建模，随后进行 T 型管设计的演示。该病例的成功为未来个性化气道假体设计和制造提供了一种可能的途径。
