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山东大学学报 (医学版) ›› 2020, Vol. 58 ›› Issue (7): 72-76.doi: 10.6040/j.issn.1671-7554.0.2020.0125

• • 上一篇    

Ⅰ期端端吻合术治疗重度颈段气管狭窄临床分析

郭志华1,赵大庆1,邢园2,王薇1,梁乐平1,杨静1,赵倩倩1   

  1. 1. 空军军医大学附属唐都医院耳鼻咽喉头颈外科, 陕西 西安 710038;2. 西安交通大学附属红会医院耳鼻咽喉-头颈外科, 陕西 西安 710054
  • 发布日期:2020-07-10
  • 通讯作者: 王薇. E-mail:wwei.com@163.com

Single-stage end-to-end anastomosis in the management of severe cervical tracheal stenosis

GUO Zhihua1, ZHAO Daqing1, XING Yuan2, WANG Wei1, LIANG Leping1, YANG Jing1, ZHAO Qianqian1   

  1. 1. Department of Otorhinolaryngology, Head and Neck Surgery, Xian Tangdu Hospital, Air Force Medical University, Xian 710038, Shaanxi, China;
    2. Department of Otorhinolaryngology Head and Neck Surgery, Xian Honghui Hospital, Xian Jiaotong University, Xian 710054, Shaanxi, China
  • Published:2020-07-10

摘要: 目的 探讨Ⅰ期气管、环气管部分切除端端吻合术在治疗重度颈段气管狭窄中的有效性、适应证和风险因素。 方法 回顾性分析2015年3月至2019年11月采用Ⅰ期部分气管、环气管切除端端吻合术治疗的重度颈段气管狭窄患者29例。其中男19例,女10例,17~51岁,平均31岁。手术方法包括气管-气管端端吻合(18例)、环气管吻合(9例)和甲状软骨气管吻合(2例)。狭窄程度按照Myer-Cotton法分为Ⅲ度18例,Ⅳ度11例。 结果 狭窄长度1~4 cm,平均2.5 cm。一次性手术成功拔管25例(86%)。术后并发症:皮下气肿1例,再次狭窄4例,吻合口裂1例,暂时性声带麻痹1例。 结论 Ⅰ期端端吻合术是一种有效治疗重度颈段气管狭窄的手术方法,手术成功率高。严格的术前适应证选择和术者经验是手术成功的关键。

关键词: 气管狭窄, 手术, 吻合术, 并发症, 再手术

Abstract: Objective To evaluate the efficacy, indications and risk factors of single-stage end-to-end anastomosis in the treatment of severe cervical tracheal stenosis. Methods A retrospective analysis was performed on 29 patients with severe cervical tracheal stenosis treated with single-stage partial tracheal or cricotracheal resection with primary end-to-end anastomosis during Mar. 2015 and Nov. 2019, including 19 male and 10 female, age ranged from 17 to 51(mean 31)years. Tracheotracheal end-to-end anastomosis was performed in 18 cases, cricotracheal end-to-end anastomosis in 9 cases and thyrotracheal anastomosis in 2 cases. The degree of stenosis was classified according to Myer-Cotton classification as grade Ⅲ in 18 cases and grade Ⅳ in 11 cases. Results Length of stenosis was 1-4 cm(mean 2.5 cm). Successful decannulation was achieved in 25 cases(86%). Postoperative complications included subcutaneous emphysema in 1 case, restenosis in 4 cases, anastomosic dehiscence in 1 case, and temporary unilateralvocal fold palsy in 1 case. Conclusion Single-stage end-to-end anastomosis is safe and effective in the management of advanced cervical tracheal stenosis. Careful preoperative evaluation of indications and operators experiences play the most important roles in achieving a positive outcome.

Key words: Tracheal Stenosis, Surgery, Anastomosis, Complications, Reoperation

中图分类号: 

  • R653
[1] 陈文弦, 迟汝澄, 刘文忠, 等. 喉气管狭窄重建术20年经验[J]. 中华耳鼻咽喉科杂志, 1997, 32(5): 302-304. CHEN Wenxuan, CHI Rucheng, LIU Wenzhong, et al. Reconstruction of laryngotraeheal stenosis: experience of twenty years [J]. Chinese Journal of Otorhinolaryngology, 1997, 32(5): 302-304.
[2] Myer CM, OConnor DM, Cotton RT. Proposed grading system for subglottic stenosis based on endotracheal tube sizes [J]. Ann Otol Rhinol Laryngol, 1994, 103(4Pt 1): 319-323.
[3] 崔鹏程, 罗家胜, 刘志, 等. 气管节段切除端对端吻合术治疗颈段气管瘢痕性狭窄[J]. 中华耳鼻咽喉头颈外科杂志, 2016, 51(2): 95-99. CUI Pengcheng, LUO Jiasheng, LIU Zhi, et al. Segmental tracheal resection and anastomosis for the treatment of cicatricial stenosis in cervical tracheal [J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2016, 51(2): 95-99.
[4] Auchincloss HG, Wright CD. Complications after tracheal resection and reconstruction: prevention and treatment [J]. Thorac Dis, 2016, 8(Suppl 2): 160-167.
[5] Pookamala S, Kumar R, Thakar A, et al. Laryngotracheal stenosis: clinical profile, surgical management and outcome [J]. Indian J Otolaryngol Head Neck Surg, 2014, 66(Suppl 1): 198-202.
[6] Liu L, Wu W, Ma Y, et al. Laryngotracheal resection and reconstruction for subglottic tracheal stenosis-our experience of 32 cases [J]. Clin Otolaryngol, 2015, 40(2): 143-147.
[7] Marques P, Leal L, Spratley J, et al. Tracheal resection with primary anastomosis: 10 years experience [J]. Am J Otolaryngol, 2009, 30(6): 415-418.
[8] Rubikas R, Matukaityte I, Jelisiejevas JJ, et al. Surgical treatment of non-malignant laryngotracheal stenosis [J]. Eur Arch Otorhinolaryngol, 2014, 271(9): 2481-2487.
[9] Nandakumar R, Jagdish C, Prathibha CB, et al. Trachealresection with end-to-end anastomosis for post-intubation cervical tracheal stenosis: study of 14 cases [J]. Laryngol Otol, 2011, 125(9): 958-961.
[10] Morcillo A, Wins R, Gomez-Caro A, et al. Single-staged laryngotracheal reconstruction for idiopathic tracheal stenosis [J]. Ann Thorac Surg, 2013, 95(2): 433-439.
[11] Atallah I, Aldkhyyal A, Castellanos PF. Modified single-stage segmental cricotracheal resection [J]. Eur Arch Otorhinolaryngol, 2018, 275(1): 139-146.
[12] Sinacori JT, Taliercio SJ, Duong E, et al. Modalities of treatment for laryngotracheal stenosis: the EVMS experience [J]. Laryngoscope, 2013, 123(12): 3131-3136.
[13] 陈文弦, 阮炎艳, 崔鹏程, 等. 探讨肋软骨瓣移植成形术治疗重症喉气管狭窄成败原因[J]. 中华耳鼻咽喉头颈外科杂志, 2002, 37(5): 377-379. CHEN Wenxuan, RUAN Yanyan, CUI Pengcheng, et al. Rib cartilage graft laryngotracheal reconstruction for severe laryngotrac heal stenosis [J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2002, 37(5): 377-379.
[14] Grillo HC, Donahue DM, Mathisen OJ, et al. Postintubation tracheal stenosis:treatment and results [J]. J Thorac Cardiovasc Surg, 1995, 109(3): 486-493.
[15] Gozen ED, Karaman E, Erdur ZB, et al. End-to-end anastomosis in the management of laryngotracheal defects [J]. J Laryngol Otol, 2017, 131(5): 447-454.
[16] Byanet O, Bosha JA, Onoja BO. A quantitative study on the trachea of the red sokoto(Maradi)goat(Capra hircus)[J]. Vet Med Int, 2014, 2014: 142715. doi: 10.1155/2014/142715.
[17] Goh CS, Joethy JV, Tan BK, et al. Large animal models for long-segment tracheal reconstruction: a systematic review [J]. J Surg Res, 2018, 231:140-153. doi: 10.1016/j.jss.2018.05.025.
[18] Farzanegan R, Feizabadi M, Ghorbani F. An overview of tracheal stenosis research trends and hot topics [J]. Arch Iran Med, 2017, 20(9): 598-607.
[19] Manning PB, Rutter MJ, Lisec A, et al. One slide fits all: The versatility of slide tracheoplasty with cardiopulmonary bypass support for airway reconstruction in children [J]. J Thorac Cardiovasc Surg, 2011, 141(1): 155-161.
[20] Butler CR, Speggiorin S, Rijnberg FM, et al. Outcomes of slide tracheoplasty in 101 children: a 17-year single-center experience [J]. J Thorac Cardiovasc Surg, 2014, 147(6): 1783-1789.
[21] Redmann AJ, Rutter MJ, de Alarcon A, et al. Cervical slide tracheoplasty in adults with laryngotracheal stenosis [J]. The Laryngoscope, 2019, 129(4): 818-822.
[22] El-Fattah AMA, Ebada HA, Amer HE, et al. Partial cricotracheal resection for severe upper tracheal stenosis: Potential impacts on the outcome [J]. Auris Nasus Larynx, 2018, 45(1): 116-122.
[23] Mathisen. Distal Tracheal resection and reconstruction: state of the art and lessons learned [J]. Thorac Surg Clin, 2018, 28(2): 199-210.
[24] Negm H, Mosleh M, Fathy H. Circumferential tracheal resection with primary anastomosis for post-intubation tracheal stenosis: study of 24 cases [J]. Eur Arch Otorhinolaryngol, 2013, 270(10): 2709-2717.
[25] Kanlikama, Muzaffer, Celenk, et al. Cervical tracheal resection and anastomosis for postintubation tracheal stenosis [J]. J Craniofac Surg, 2018, 29(6): 578-582.
[26] El-Nori AA, Mostafa AM, Elsayed H, et al. First-line tracheal resection and primary anastomosis for postintubation tracheal stenosis [J]. Ann R Coll Surg Engl, 2016, 98(6): 425-430.
[27] Nakache G, Primov-Fever A, Alon EE, et al. Predicting outcome in tracheal and cricotracheal segmental resection [J]. Eur Arch Otorhinolaryngol, 2015, 272(6): 1471-1475.
[28] El-Fattah AM, Kamal E, Amer HE, et al. Cervical tracheal resection with cricotracheal anastomosis: experience in adults with grade III-IV tracheal stenosis [J]. J Laryngol Otol, 2011, 125(6): 614-619.
[29] Jyoti Dabholkar, Arpit Sharma, Nitish Virmani, et al. Management of benign laryngotracheal stenosis-A 5-year experience of Indian tertiary care setup [J]. J Head Neck Physician Surg, 2018, 6(1): 35-42.
[30] Wright CD, Grillo HC, Wain JC, et al. Anastomotic complications after tracheal resection: prognostic factors and management [J]. Thorac Cardiovasc Surg, 2004, 128(5): 731-739.
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