气管外科临床治疗方法的探讨

Tracheal surgical experience with 15 patients

目的 总结气管外科的临床经验 ,包括手术切除重建、人工气管、经气管镜冷冻治疗和金属支架。方法 回顾性分析 1991年 1月至 2 0 0 3年 4月 15例气管手术患者的临床资料。结果 常见的组织类型为腺癌 4例 ,腺样囊性癌 3例 ,良性瘤 4例 (3例混合瘤 ,1例平滑肌瘤 ) ;其次是鳞状细胞癌 1例 ,类癌 1例 ,无病理 1例 ,外伤后狭窄 1例。本组病例采用多种手术方法 :1例应用碳素气管假体 ;1例应用带肌肉血管蒂的金属网管重建气管 ;1例经硬式支气管镜冷冻治疗 ;9例气管节段切除 ,切除范围 2 0～ 4 0mm ,行端端吻合术 ;3例放金属支架。 15例中 6例在体外循环辅助下完成 ;3例术后放疗 ,1例术后内镜激光治疗。术后吻合口裂开 1例 ,导致纵隔炎、双侧肺炎死亡 ;局部复发 1例。随访至 2 0 0 3年 10月 ,12例患者仍存活。结论 原发性恶性肿瘤和某些良性肿瘤需要大范围的气管节段切除。气管肿瘤的手术方法是多种多样的 ,应根据肿瘤的范围采取不同的手术方法。

Objective To summarize the clinic experience of surgical management of tracheal tumors including reconstruction,artificial trachea,cryotherapy of interventional endoscopy,and metal tent.Methods To analyze retrospectively the data of 15 patients undergone resection and reconstruction of the trachea for tracheal operation between January 1991 and April 2003.Results The most common histological finding was adenocarcinoma(n=4),adenoid cystic carcinoma (n=3),benign tumors (n=4,mixed tumor and leiomyoma)followed by a squamous cell carcinoma (n=1),a carcinoid tumor (n=1),no pathological diagnosis (n=1) and injuring stenosis (n=1).Various reconstructive techniques were used,one carbon prosthesis and a metal net tube with musculovascular pedicle was implanted.A patient received cryotherapy with rigid tracheal endoscopy.The segment of trachea between 20mm and 40mm in nine patients were resected and reconstructed.The stent was placed in 3 patients.The extracorporeal circulation was employed in six patients,postoperative external beam radiotherapy in 3 cases and endoluminal laser therapy by interventional endoscopy in one case.A major postoperative wound-healing impairment at the anastomosis occurred and died postoperatively of mediastinitis with bilateral pneumonia.A local recurrence was observed in only one case.At the last follow-up in Oct. 2003,12 patients were still alive.Conclusions Extensive segmental resection of the trachea is the treatment of choice for primary malignancy and occasionally for benign tracheal tumors.The methods of treatment for tracheal tumor are various according to the extent of tumor.