He Jiaxi, Yang Chao, Yang Hanyu, Chen Hanzhang, He Jianxing, Li Shuben
Department of Thoracic Surgery, the First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China.
Guangzhou Institute of Respiratory Disease & China State Key Laboratory of Respiratory Disease, Guangzhou, China.
Transl Lung Cancer Res. 2022 Apr;11(4):600-606. doi: 10.21037/tlcr-22-177.
The tracheal tumor is a rare disease with low incidence in the upper airway. Surgical resection and reconstruction are effective and radical treatments for such conditions, but the approaches vary depending on the tumor location. The current report tends to illustrate the clinical practice and advantage of the median sternotomy approach for treating tracheal tumors.
We summarized and demonstrated four cases of tracheal tumors patients who received tracheal resection and reconstruction via median sternotomy approach in our institute. Their clinical data and surgical procedures were also described. The follow-up would be carried on to monitor their prognosis after the operations.
Two patients with lower tracheal tumors involving carina received sternotomies, one with the tumor in cervical, thoracic junction, and the other one with thyroid carcinoma involving and extending to the thoracic trachea received half-sternotomies. The surgical procedures were completed smoothly with ideal surgical vision and sufficient operative space. Case 1 and 2 patients underwent tracheal-bronchial end-to-side anastomosis, while the other two patients received end-to-end anastomosis. The thymus and mediastinal tissue were used as the anastomotic buttress. They were discharged no more than 2 weeks after operations. Case 4 was suffered from aspiratory pneumonia and experienced prolonged intensive care unit (ICU) stay and antibiotic use. No other severe complications were recorded in other cases. No anastomotic dehiscence was observed in the postoperative bronchoscopy.
Tracheal resection and reconstruction via sternotomy or half-sternotomy is a practical approach for intrathoracic tracheal lesions. It facilitates a satisfying field and anastomosis procedure. The reported cases had ideal surgical outcomes. Although it is convenient in some specific cases, further studies are warranted for its safety and efficacy.
气管肿瘤是一种在上呼吸道发病率较低的罕见疾病。手术切除和重建是治疗此类疾病的有效且根治性的方法，但手术方式因肿瘤位置而异。本报告旨在阐述经正中胸骨切开术治疗气管肿瘤的临床实践及优势。
我们总结并展示了在我院接受经正中胸骨切开术行气管切除重建的4例气管肿瘤患者。描述了他们的临床资料和手术过程。术后将进行随访以监测其预后。
2例累及隆突的低位气管肿瘤患者接受了胸骨切开术，1例肿瘤位于颈胸交界处，另1例甲状腺癌累及并延伸至胸段气管的患者接受了半胸骨切开术。手术过程顺利，手术视野理想，手术空间充足。病例1和2患者行气管-支气管端侧吻合，另外2例患者行端端吻合。胸腺和纵隔组织用作吻合支撑。他们术后不超过2周出院。病例4发生吸入性肺炎，在重症监护病房（ICU）停留时间延长且使用了抗生素。其他病例未记录到其他严重并发症。术后支气管镜检查未观察到吻合口裂开。
经胸骨切开术或半胸骨切开术行气管切除重建是治疗胸段气管病变的一种实用方法。它有助于获得满意的手术视野和吻合操作。报告的病例手术效果理想。尽管在某些特定情况下方便，但仍需进一步研究其安全性和有效性。
