气管袖状切除及断端一期吻合手术治疗良性颈段气管狭窄

Cervical tracheal resection with primary anastomosis for benign tracheal stricture in adult

目的 探讨采用气管袖状切除及断端一期吻合手术治疗良性颈段气管狭窄的疗效及并发症的预防.方法 回顾性分析2009年10月至2012年6月收治的12例因不同病因所致良性颈段气管狭窄并接受手术治疗的病例.术前采用纤维电子喉镜、螺旋CT及三维重建对颈段气管狭窄的位置、范围及局部炎性反应水肿情况进行评估.采用The Myer-Cotton grading系统评价气管狭窄的严重程度.全部病例采用气管袖状切除后断端一期吻合.结果 本组中气管狭窄长度为2.3～4.1 cm.颈段气管狭窄的严重程度：Ⅰ级0例；Ⅱ级3例；Ⅲ级7例；Ⅳ级2例.12例患者术后全部顺利拔管,术后出现暂时性声音嘶哑1例次（8.3％）,单侧肺不张合并胸腔积液1例次（8.3％）,皮下气肿伴伤口感染1例次（8.3％）,轻度吞咽困难3例次（25.0％）,气管吻合口炎性肉芽组织增生3例次（25.0％）,暂时性音调变低5例次（41.7％）.未出现吻合口瘘或断裂等严重并发症.所有病例随访6 ～38个月未出现气管再次狭窄致呼吸困难情况.结论 气管袖状切除并断端一期吻合术手术成功率高,疗效显著,是治疗颈段良性气管狭窄安全可靠的治疗方法,术前应谨慎评估和严格把握适应证.

Objective To introduce the outcomes of tracheal resection with primary end to end anastomosis for benign cervical tracheal stenosis,and to discuss the strategy for prevention of surgical complications.Methods A retrospective analysis was performed in 12 patients diagnosed as benign cervical tracheal stenosis from October 2009 to June 2012.Laryngo-tracheal endoscopic examination and computed tomography （CT） were used to assess the degree of stenosis,the grade of inflammation and edema of the subglottis and trachea,and the extent of stenosis and the remaining linear amount of normal airway.The Meyer and Cotton grading system was used to categorise the clinical severity of the stenoses.All patients underwent tracheal resection with primary end to end anastomosis.Results The length of cervical tracheal stenosis ranged from 2.3 to 4.1 cm.Grade Ⅱ stenosis was present in three patients,Grade Ⅲ stenosis was present in seven patients and grade Ⅳ stenosis in two patients.Successful extubation was achieved in all 12 cases.After surgery,temporary hoarseness occurred in 1 patient （8.3%）; unilateral pulmonary atelectasis with pleural effusion occurred in 1 patient （8.3%） ; subcutaneous emphysema with infection occurred in 1 patient （8.3%） ; mild dysphagia occurred in 3 patients （25.0%） ; a slight deepening of the tone of voice occurred in 5 patients （41.7%）,granulation tissue growth near the suture occurred in 3 patients （25.0%）,and suture dehiscence did not occur in any patient.The follow-up period ranged from 6 months to 38 months,no patient developed restenosis.Conclusions It presents a high success rate and good functional result of tracheal resection with primary end-to-end anastomosis.Therefore,it is an effective and reliable approach for the management of benign cervical tracheal stenosis.To avoid complications,the preoperative assessment,patients selection and postoperative management should be emphasized.