Ferreirinha Joana, Caviezel Claudio, Weder Walter, Opitz Isabelle, Inci Ilhan
Department of Thoracic Surgery, University Hospital of Zürich, Switzerland.
Swiss Med Wkly. 2020 Dec 30;150:w20383. doi: 10.4414/smw.2020.20383. eCollection 2020 Dec 14.
Tracheal or cricotracheal resection is the standard of care for definitive treatment of tracheal stenosis. However, the incidence is low, the management is complex, and only a few centres have reported their experience. Therefore, more clinical reports on this topic are needed.
We performed a retrospective analysis of all patients who underwent tracheal or cricotracheal resection for malignant or benign tracheal stenosis in our institution between 2001 and 2016. Fisher’s exact test was used for analysis of complications and recurrence. P-value <0.05 was considered statistically significant.
37 patients, aged 19–74, underwent tracheal (n = 21, 56.8%) or cricotracheal (n = 16, 43.2%) resection for idiopathic (n = 15, 40.5%), neoplasm-related (n = 11, 29.7%), postintubation/-tracheotomy (n = 10, 27%), and congenital (n = 1, 2.7%) stenosis. Cervical incision was applied in 28 patients (75.7%), and an extended access (5 thoracotomy, 3 hemiclamshell, 1 partial-sternotomy) was required in 9 patients (24.3%). Mediastinal lymphadenectomy was done in 7 patients (18.9%), all with neoplasm-related stenosis. Median resection length was 2.8 cm (range 1.0–6.0), and longer than 4.0 cm in 6 cases (16.2%). Release manoeuvre was performed in 7 patients (18.9%). All patients were extubated immediately after surgery and median hospital stay was 5 days (range 3–15). Median follow-up was 6 months (range, 1-93). There was no 30-day mortality, and no dehiscence or fistula occurred at the suture line. Complications were seen in 11 patients (29.7%), significantly correlating to malignant stenosis (p = 0.011) and surgical procedure, meaning extended access (p = 0.011), mediastinal lymphadenectomy (p = 0.016), and release manoeuvres (p = 0.016). Temporary hoarseness was the most common complication (n = 5, 13.5%), but remained persistent in only one patient (n = 1, 2.7%). Recurrence was seen only in patients with idiopathic stenosis (n = 5, 13.5%).
Our results confirm good efficacy for surgical resection of tracheal stenosis. The complication rate is relatively low in comparison to the literature, suggesting the importance of managing tracheal stenosis in a tertiary referral centre.
气管或环状气管切除术是气管狭窄确定性治疗的标准术式。然而，其发病率较低，治疗复杂，仅有少数中心报道过相关经验。因此，需要更多关于该主题的临床报告。
我们对2001年至2016年间在我院因恶性或良性气管狭窄接受气管或环状气管切除术的所有患者进行了回顾性分析。采用Fisher精确检验分析并发症和复发情况。P值<0.05被认为具有统计学意义。
37例患者，年龄19至74岁，因特发性（n = 15，40.5%）、肿瘤相关（n = 11，29.7%）、插管/气管切开术后（n = 10，27%）和先天性（n = 1，2.7%）狭窄接受了气管（n = 21，56.8%）或环状气管（n = 16，43.2%）切除术。28例患者（75.7%）采用颈部切口，9例患者（24.3%）需要扩大入路（5例开胸手术、3例半蛤壳式切口、1例部分胸骨切开术）。7例患者（18.9%）进行了纵隔淋巴结清扫，均为肿瘤相关狭窄。中位切除长度为2.8 cm（范围1.至6.0），6例（16.2%）超过4.0 cm。7例患者（18.9%）进行了松解操作。所有患者术后立即拔管，中位住院时间为5天（范围3至15天）。中位随访时间为6个月（范围1至93个月）。无30天死亡率，缝合处无裂开或瘘管形成。11例患者（29.7%）出现并发症，与恶性狭窄（p = 0.011）和手术操作显著相关，即扩大入路（p = 0.011）、纵隔淋巴结清扫（p = 0.016）和解松操作（p = 0.016）。暂时性声音嘶哑是最常见的并发症（n = 5，13.5%），但仅1例患者（n = 1，2.7%）持续存在。仅特发性狭窄患者出现复发（n = 5，13.5%）。
我们的结果证实了气管狭窄手术切除的良好疗效。与文献相比，并发症发生率相对较低，提示在三级转诊中心治疗气管狭窄的重要性。
