Stamatis Georgios, Fechner Sylvia, Rocha Miguel, Weinreich Gerhard
Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Department of Thoracic Surgery and Endoscopy, Ruhrlandklinik, West German Lung Center, University Hospital Essen, University Duisburg-Essen, Essen, Germany.
Ann Thorac Surg. 2017 Nov;104(5):1741-1747. doi: 10.1016/j.athoracsur.2017.05.053. Epub 2017 Sep 19.
The resection of the tracheobronchial bifurcation with complete preservation of lung parenchyma remains a challenge owing to the limited indications for surgery, anesthesiologic management, operative technique, and postoperative course. The aim of this retrospective study was to evaluate factors influencing the perioperative course and long-term survival.
Between 1989 and 2014, 19 patients underwent a resection of the distal trachea and carina with complete preservation of lung tissue, 16 for malignant tumors (7 adenoid cystic carcinomas, 3 carcinoid tumors, 3 mucoepidermoid tumors, 2 squamous cell carcinomas, and 1 small cell carcinomas), 2 for inflammatory stenosis, and 1 after a complex traumatic rupture.
Surgical approach was posterolateral thoracotomy in 17 patients and median sternotomy in 2. In 16 patients, end-to-end anastomosis was performed, and in 3 patients, combined end-to-end and side-to-end anastomosis were performed. The operative mortality was 0%, the perioperative complication rate was 26.3%. Six patients with adenoid cystic carcinoma and all patients with lung carcinoma received adjuvant radiotherapy; only 1 patient with small cell lung cancer had chemotherapy before surgery. Long-term results are excellent in patients with benign disease, typical and atypical carcinoid tumor, mucoepidermoid carcinoma, and in most patients with adenoid cystic carcinoma. Two patients with lung cancer died 28 and 45 months after surgery, and 1 patient with adenoid cystic carcinoma died 75 months after surgery.
Resection of the tracheobronchial bifurcation with complete preservation of lung indicated for selected patients with local tumor growth at the distal trachea and carina provides low perioperative mortality and complications and results in long-term survival rates.
由于手术适应症、麻醉管理、手术技术及术后病程等方面的限制，在完全保留肺实质的情况下切除气管支气管分叉仍然是一项挑战。本回顾性研究的目的是评估影响围手术期病程及长期生存的因素。
1989年至2014年间，19例患者接受了远端气管及隆突切除并完全保留肺组织，其中16例因恶性肿瘤（7例腺样囊性癌、3例类癌肿瘤、3例黏液表皮样癌、2例鳞状细胞癌和1例小细胞癌），2例因炎性狭窄，1例因复杂创伤性破裂。
17例患者采用后外侧开胸手术，2例采用正中胸骨切开术。16例患者进行了端端吻合，3例患者进行了端端与端侧联合吻合。手术死亡率为0%，围手术期并发症发生率为26.3%。6例腺样囊性癌患者及所有肺癌患者均接受了辅助放疗；仅1例小细胞肺癌患者在手术前接受了化疗。良性疾病、典型及非典型类癌肿瘤、黏液表皮样癌患者以及大多数腺样囊性癌患者的长期预后良好。2例肺癌患者分别在术后28个月和45个月死亡，1例腺样囊性癌患者在术后75个月死亡。
对于远端气管和隆突处局部肿瘤生长的特定患者，在完全保留肺的情况下切除气管支气管分叉可降低围手术期死亡率和并发症发生率，并获得长期生存率。
