Bolton William D, Ben-Or Sharon, Hale Allyson L, Stephenson James E
From the Division of Thoracic Surgery, Department of Surgery, Greenville Health System, Greenville, SC USA.
Innovations (Phila). 2017 Mar/Apr;12(2):137-139. doi: 10.1097/IMI.0000000000000347.
This case describes successful reconstruction of a long-segment tracheal defect using AlloDerm as the conduit for reconstruction. A 38-year-old woman who had undergone a thyroid lobectomy in 2011 presented several months later unable to swallow. Chest computed tomography results revealed a tracheal/esophageal mass and a subsequent bronchoscopy, and esophagogastroduodenoscopy results revealed an upper esophageal/tracheal mass with two areas concerning for fistula. She underwent a bronchoscopy with a tracheal stent and percutaneous endoscopic gastrostomy placement. All biopsies were nondiagnostic for malignancy and the patient recovered well. After a repeat bronchoscopy and esophagogastroduodenoscopy a few months later, she underwent a diagnostic right video-assisted thoracoscopic surgery and thoracotomy. To obtain adequate tissue for diagnosis, the fistula was opened, resulting in a large defect in the esophagus and trachea, as portions of the trachea, esophagus, and right recurrent laryngeal nerve liquefied. A 7-cm portion of her esophagus, 8 cm of the posterior trachea, and 5 cm of the right trachea wall were removed. The pathology came back as Hodgkin lymphoma. Because of the size of the esophageal defect, reconstruction was not an option. Therefore, the remainder of the esophagus was resected, the stomach stapled off, and esophageal hiatus closed. The tracheal defect was also too large for patch repair and was reconstructed with a tube of AlloDerm (6 × 10 cm). Four years after reconstruction, the patient is disease free and living a normal life. This case demonstrates successful tracheal reconstruction with AlloDerm.
本病例描述了使用同种异体脱细胞真皮基质（AlloDerm）作为重建管道成功修复长段气管缺损的过程。一名38岁女性在2011年接受了甲状腺叶切除术，数月后出现吞咽困难。胸部计算机断层扫描结果显示气管/食管肿物，随后的支气管镜检查以及食管胃十二指肠镜检查结果显示食管上段/气管肿物，有两个部位疑似瘘管形成。她接受了气管支架置入的支气管镜检查和经皮内镜下胃造口术。所有活检均未诊断出恶性肿瘤，患者恢复良好。几个月后，在重复进行支气管镜检查和食管胃十二指肠镜检查后，她接受了诊断性右电视辅助胸腔镜手术和开胸手术。为获取足够的组织进行诊断，打开了瘘管，导致食管和气管出现大的缺损，部分气管、食管和右侧喉返神经液化。切除了她7厘米长的食管、8厘米长的气管后壁以及5厘米长的右侧气管壁。病理结果为霍奇金淋巴瘤。由于食管缺损较大，无法进行重建。因此，切除了剩余的食管，缝合关闭胃，封闭食管裂孔。气管缺损也太大，无法进行补片修复，遂用一段同种异体脱细胞真皮基质（6×10厘米）进行重建。重建四年后，患者无疾病复发，过着正常生活。本病例展示了使用同种异体脱细胞真皮基质成功进行气管重建的过程。
