Kato R, Kakizaki T, Hangai N, Sawafuji M, Yamamoto T, Kobayashi T, Watanabe M, Nakayama M, Kawamura M, Kikuchi K
Department of Surgery, School of Medicine, Keio University, Tokyo, Japan.
J Thorac Cardiovasc Surg. 1993 Dec;106(6):1118-21.
Thirty-six patients underwent tracheobronchoplastic procedures for treatment of tuberculous tracheobronchial stenosis. The modes of operations were left upper sleeve lobectomy in 13 patients, sleeve resection of the left main bronchus in 12 patients (two underwent concomitant left upper lobectomy), right upper sleeve lobectomy in five patients, sleeve resection of the right intermediate bronchus in two patients, right sleeve superior segmentectomy of the lower lobe in one patient, sleeve resection of the trachea with concomitant left pneumonectomy in one patient, carinal resection with right upper sleeve lobectomy and middle lobectomy in one patient, and dilatation of the left main bronchus with a free skin graft reinforced with a steel wire in one patient. One patient died of pulmonary edema of unknown cause on the first postoperative day. Anastomotic stenosis occurred in seven patients. One of these patients underwent reoperation and six underwent endoscopic dilatation. One patient died in the hospital of massive bleeding during endoscopic dilatation 4 months after operation. Slight to moderate stenosis resulted in the remaining patients. Although there are some complications, we believe bronchoplastic operation is worthwhile for restoring pulmonary function in patients with tuberculous tracheobronchial stenosis.
36例患者接受了气管支气管成形术治疗结核性气管支气管狭窄。手术方式包括:13例行左上叶袖状肺叶切除术,12例行左主支气管袖状切除术(其中2例同时行左上叶切除术),5例行右上叶袖状肺叶切除术,2例行右中间支气管袖状切除术,1例行右下叶袖状上叶切除术,1例行气管袖状切除术并同期左全肺切除术,1例行隆突切除并右上叶袖状肺叶切除术及中叶切除术,1例行左主支气管扩张术并用钢丝加固的游离皮片修补。1例患者术后第1天死于原因不明的肺水肿。7例患者发生吻合口狭窄,其中1例行再次手术,6例行内镜扩张术。1例患者术后4个月在内镜扩张术中死于大出血。其余患者存在轻度至中度狭窄。尽管有一些并发症,但我们认为气管支气管成形术对于恢复结核性气管支气管狭窄患者的肺功能是值得的。