Lorntzsen Bianca, Brøndbo Kjell, Osnes Terje
Institute of Clinical Medicine, Faculty of Medicine, University of Oslo Norway.
Department of Otorhinolaryngology, Head and Neck Surgery, Division of Head, Neck and Reconstructive Surgery Oslo University Hospital Oslo Norway.
Laryngoscope Investig Otolaryngol. 2020 Sep 23;5(5):961-968. doi: 10.1002/lio2.463. eCollection 2020 Oct.
We aimed to evaluate the outcomes of tracheal window resection and reconstruction using a vascularized periosteal flap (intended for calcification) harvested from the medial clavicle. This is one of several surgical techniques for tracheal resection and reconstruction used for patients with thyroid carcinoma invading the trachea. Importantly, in partial tracheal resection postoperative dynamic airway collapse must be prevented. Reconstruction of the tracheal defect with a vascularized periosteal flap is one method of achieving a stable airway.
Twelve patients with locally advanced thyroid carcinoma who underwent tracheal resection and reconstruction at Oslo University Hospital from 2004 to 2017 were studied retrospectively. The primary outcome was a stable airway not requiring airway stenting. The secondary outcomes were the time to decannulation, morbidity, and survival.
Eleven of 12 patients did not require airway stenting postoperatively after a median of 111 days. Seven patients developed postoperative complications. The median observation time was 74.8 months (range 10.5-153.5) for all patients. The median disease-free survival was 40 months (range 0-147). By February 1, 2020, seven patients were alive, of whom five showed no evidence of disease.
Tracheal reconstruction with a vascularized periosteal flap yielded good results in terms of establishing a stable airway. This procedure is a viable reconstructive option that allows for decannulation by preventing airway collapse, thereby potentially mitigating the need for end-to-end (ETE) anastomosis or sleeve resections. For selected patients, this procedure may prevent local fatal complications from thyroid cancer invading the trachea.
Level 4.
我们旨在评估使用从锁骨内侧获取的带血管蒂骨膜瓣（用于钙化）进行气管窗切除及重建的效果。这是用于治疗甲状腺癌侵犯气管患者的几种气管切除及重建手术技术之一。重要的是，在部分气管切除术后必须防止动态气道塌陷。用带血管蒂骨膜瓣重建气管缺损是实现稳定气道的一种方法。
对2004年至2017年在奥斯陆大学医院接受气管切除及重建的12例局部晚期甲状腺癌患者进行回顾性研究。主要结局是无需气道支架置入的稳定气道。次要结局是拔管时间、发病率和生存率。
12例患者中有11例在中位时间111天后术后无需气道支架置入。7例患者出现术后并发症。所有患者的中位观察时间为74.8个月（范围10.5 - 153.5）。无病生存期的中位数为40个月（范围0 - 147）。截至2020年2月1日，7例患者存活，其中5例无疾病证据。
用带血管蒂骨膜瓣进行气管重建在建立稳定气道方面取得了良好效果。该手术是一种可行的重建选择，通过防止气道塌陷实现拔管，从而可能减少端端吻合术或袖状切除术的需求。对于选定的患者，该手术可预防甲状腺癌侵犯气管导致的局部致命并发症。
4级。
