气管巨大癌肿斜行袖式切除“Z”字成形吻合术(附1例报告)

“Z” tracheoplasty of oblique sleeve resection of huge tracheal tumor

目的 :探讨研究一种新的气管成形吻合术在气管肿瘤外科的应用价值。方法 :对 1例肿瘤的长度 5 8cm的气管中段鳞癌的病例采用右胸后外切口 ,在切断右下肺韧带、环形切开右肺门整圈心包返折、充分游离隆突及左、右总支气管的基础上 ,设计在上下气管斜形断端的一侧行小范围间断缝合 ,使之气管长度适当加长、在此基础上再施行“Z”字成形吻合术。结果 :气管巨大癌肿切除后气管断端直接成形吻合获得一期愈合 ,随访一年 ,情况良好。结论 :对肿瘤巨大的气管癌肿可根据病灶的具体情况 ,灵活设计斜行袖式切除和包括“Z”字成形吻合等多种形式的成形吻合术 ,可取得满意的临床效果 。

Purpose:To discuss and study the practical value of a new tracheoplasty technique in tracheal cancer surgery.Methods:A right posteroexternal thoracotomy was performed on a case with squamous cell carcinoma (5.8 cm long) in the middle segment of the trachea. After cutting off the right lower ligament pulmonale, incising circularly the whole pericardium fold in the right pulmonary hilum, and dissociating adequately the main bronchi of both sides, we adopted a method of suturing in one side of the oblique fault ends of the upper and lower trachea to elongate the trachea, then we performed the “Z” tracheoplasty.Results:Healing by first intention was acquired by the tracheoplasty after the huge tumor was removed.The patient was in good condition at one year follow up. Conclusions:For huge tracheal tumors, flexible oblique sleeve resection and modes of tracheoplasty including the “Z” tracheoplasty can be performed and achieve satisfactory clinical results.