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[气管切除技术的发展——我们的经验]

[Development of tracheal resection technique - our experience].

作者信息

Schützner J, Šimonek J, Stolz A, Kolařík J, Pozniak J, Bobek V, Pafko P, Lischke R

出版信息

Rozhl Chir. 2016 Jan;95(1):19-24.

Abstract

INTRODUCTION

Tracheal resections are very frequent interventions on the trachea in general. In borderline cases where the tracheal resection length is too high, the situation can be resolved by inserting a stent or Montgomerys T cannula. Tracheal stenoses are of benign origin in 94%, and malignant in 6% of cases. We present a summary of tracheal resection interventions for the last 21 years.

METHOD

235 tracheal resections were performed at the authors institution in 1993-2013. In total 221 benign stenosis cases (85 % developed after tracheostomy, 15% developed after intubation) and 14 malignant cases were treated. The patients were divided into two groups: A resection in years 19932002 and B - resection in years 20032013. The comparison of these two time periods is presented with focus on surgical procedures development and recommendations based on experienced complications.

RESULTS

Restenosis (early or late) is the most common complication during the process of tracheal resection treatment. Tiny fistulas in the suture can be diagnosed easily by minor air leaking and are treated conservatively without intervention. Fortunately, suture insufficiency is relatively rare. In some cases the restenoses can be resected or treated by stent application or by Montgomerys T-cannula application. Complications were observed in 2% of the treated patients, which is a number presented also by international studies.

CONCLUSION

Tracheal resection is definitely an optimal solution for patients suffering from tracheal stenosis. As presented in our study, in the hands of experienced thoracic surgeons tracheal resections is a safe and final solution of tracheal stenosis.

KEY WORDS

trachea - stenosis resection.

摘要

引言

气管切除术总体上是对气管进行的常见手术。在气管切除长度过长的临界病例中,可通过插入支架或蒙哥马利T形套管来解决。气管狭窄94%起源于良性,6%起源于恶性。我们总结了过去21年的气管切除手术情况。

方法

作者所在机构在1993年至2013年期间进行了235例气管切除术。共治疗了221例良性狭窄病例(85%在气管切开术后发生,15%在插管后发生)和14例恶性病例。患者分为两组:A组为1993年至2002年的手术病例,B组为2003年至2013年的手术病例。对这两个时间段进行了比较,重点关注手术方法的发展以及基于经验性并发症的建议。

结果

再狭窄(早期或晚期)是气管切除治疗过程中最常见的并发症。缝线处的微小瘘管可通过轻微漏气轻易诊断,并采用保守治疗无需干预。幸运的是,缝线不足相对少见。在某些情况下,再狭窄可通过再次切除或应用支架或蒙哥马利T形套管进行治疗。2%的治疗患者出现了并发症,这一数字与国际研究结果一致。

结论

气管切除术无疑是气管狭窄患者的最佳解决方案。如我们的研究所示,在经验丰富的胸外科医生手中,气管切除术是气管狭窄的安全且最终的解决方案。

关键词

气管 - 狭窄 - 切除术

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