Mansour Hoda Abd-Elmageed, Abd-Elfattah Ahmed Musaad, Kamal Elsharawy, Ebada Hisham Atef
Department of Otorhinolaryngology, Mansoura University, Mansoura, 35511, Egypt.
Eur Arch Otorhinolaryngol. 2025 May 20. doi: 10.1007/s00405-025-09441-6.
To evaluate the surgical and functional outcomes as well as the quality of life among patients who underwent revision tracheal/cricotracheal resection anastomosis for recurrent stenosis after previous unsuccessful airway surgeries.
This prospective study was conducted on 53 patients. Circumferential resection of the stenotic airway segment was done with primary end-to-end anastomosis. All surgeries were performed by the authors of this work with the same standardized surgical techniques. To decrease the anastomotic tension, suprahyoid release was performed for all patients and trachea-hyoid detensioning stitches were placed. Surgiflo was applied over the line of the anastomosis to enhance healing. Surgical and functional outcomes were evaluated.
Types of anastomosis were cricotracheal anastomosis (n = 18), thyrotracheal anastomosis (n = 24), and tracheo-tracheal anastomosis (n = 11) according to the remaining proximal and distal stumps. The overall decannulation rate was 92.5% (49 out of 53 patients). No major intraoperative complications were reported. Postoperative complications were reported in 13 patients (24.5%), in the form of restenosis (n = 7), granulation tissue formation at the site of anastomosis (n = 5), surgical emphysema / minor air leak through drains (n = 4), unilateral vocal fold paralysis (n = 2), wound seroma (n = 1). Regarding functional outcomes, dyspnea was considerably alleviated both at rest and during exercise, and most patients had satisfactory voice and swallowing related functions. The majority of patients reported adequate QOL.
Revision tracheal/cricotracheal resection anastomosis presents significant surgical challenges. Nevertheless, by employing meticulous surgical techniques and implementing strategies to reduce anastomotic tension and enhance healing such as suprahyoid release, trachea-hyoid detensioning stitches, and the application of surgiflo, high success rates and satisfactory functional outcomes were achieved.
评估既往气道手术失败后因复发性狭窄而接受气管/环状气管切除吻合术翻修的患者的手术和功能结局以及生活质量。
对53例患者进行了这项前瞻性研究。对狭窄气道段进行环形切除并进行一期端端吻合。所有手术均由本文作者采用相同的标准化手术技术进行。为降低吻合口张力，对所有患者均进行了舌骨上松解，并放置了气管-舌骨减张缝线。在吻合线上涂抹 Surgiflo 以促进愈合。评估手术和功能结局。
根据剩余的近端和远端残端，吻合方式包括环状气管吻合术（n = 18）、甲状腺气管吻合术（n = 24）和气管-气管吻合术（n = 11）。总体拔管率为92.5%（53例患者中的49例）。未报告重大术中并发症。13例患者（24.5%）报告了术后并发症，形式包括再狭窄（n = 7）、吻合口处肉芽组织形成（n = 5）、手术性肺气肿/引流管轻微漏气（n = 4）、单侧声带麻痹（n = 2）、伤口血清肿（n = 1）。关于功能结局，静息和运动时呼吸困难均得到显著缓解，大多数患者的声音和吞咽相关功能令人满意。大多数患者报告生活质量良好。
气管/环状气管切除吻合术翻修带来了重大的手术挑战。然而，通过采用精细的手术技术并实施降低吻合口张力和促进愈合的策略，如舌骨上松解、气管-舌骨减张缝线和 Surgiflo 的应用，取得了高成功率和令人满意的功能结局。
