[环状气管切除治疗瘢痕性狭窄及功能性气管造口术]

Parshin V D, Titov V A, Parshin V V, Parshin A V, Berikkhanov Z, Amangeldiev D M

Sechenov First Moscow State Medical University, Moscow, Russia, Burdenko Clinic of Faculty Surgery, Moscow, Russia.

Khirurgiia (Mosk). 2017(9):23-32. doi: 10.17116/hirurgia2017923-32.

AIM

To analyze the results of tracheal resection for cicatricial stenosis depending on the presence of tracheostomy.

MATERIAL AND METHODS

1128 patients with tracheal cicatricial stenosis were treated for the period 1963-2015. The first group consisted of 297 patients for the period 1963-2000, the second group - 831 patients for the period 2001-2015. Most of them 684 (60.6%) were young and able-bodied (age from 21 to 50 years). In the first group 139 (46.8%) out of 297 patients had functioning tracheostomy. For the period 2001-2015 tracheostomy was made in 430 (51.7%) out of 831 patients with cicatricial stenosis. Time of cannulation varied from a few weeks to 21 years.

RESULTS

Re-tracheostomy within various terms after decanulation was performed in 68 (15.8%) patients. Tracheal resection with anastomosis was performed in 59 and 330 in both groups respectively. At present time these operations are performed more often in view of their standard fashion in everyday practice. In the second group tracheal resection followed by anastomosis was observed in 110 (25.6%) out of 430 patients with tracheostomy that is 4.4 times more often than in previous years. In total 2 patients died after 330 circular tracheal resections within 2001-2015 including one patient with and one patient without tracheostomy. Mortality was 0.6%. Moreover, this value was slightly higher in patients operated with a functioning tracheostomy compared with those without it - 0.9 vs. 0.5% respectively. The causes of death were bleeding into tracheobronchial lumen and pulmonary embolism. The source of bleeding after tracheal resection was innominate artery. Overall incidence of postoperative complications was 2 times higher in tracheostomy patients compared with those without it - 22 (20%) vs. 26 (11.8%) cases respectively. Convalescence may be achieved in 89.8% patients after circular tracheal resection. Adverse long-term results are associated with postoperative complications. So their prevention and treatment will improve the outcomes.

目的

根据气管造口术的情况分析瘢痕性狭窄气管切除术的结果。

材料与方法

1963年至2015年期间对1128例气管瘢痕性狭窄患者进行了治疗。第一组包括1963年至2000年期间的297例患者，第二组包括2001年至2015年期间的831例患者。其中大多数684例（60.6%）为年轻且身体健全者（年龄21至50岁）。第一组297例患者中有139例（46.8%）有功能正常的气管造口术。2001年至2015年期间，831例瘢痕性狭窄患者中有430例（51.7%）进行了气管造口术。插管时间从几周至21年不等。

结果

脱管后不同时期内68例（15.8%）患者进行了再次气管造口术。两组分别有59例和330例进行了气管切除并吻合术。鉴于这些手术在日常实践中的标准化方式，目前进行得更为频繁。第二组430例有气管造口术的患者中有110例（25.6%）进行了气管切除并吻合术，这比前几年高出4.4倍。2001年至2015年期间，330例环形气管切除术后共有2例患者死亡，其中1例有气管造口术，1例无气管造口术。死亡率为0.6%。此外，有功能正常气管造口术的患者的这一数值略高于无气管造口术的患者，分别为0.9%和0.5%。死亡原因是气管支气管腔内出血和肺栓塞。气管切除术后出血的来源是无名动脉。气管造口术患者术后并发症的总体发生率比无气管造口术的患者高两倍，分别为22例（20%）和26例（11.8%）。环形气管切除术后89.8%的患者可康复。不良的长期结果与术后并发症有关。因此，对其预防和治疗将改善治疗效果。