赵氏人工气管临床应用远期随访

Long-term results of ZHAO＇ s artificial trachea

目的报道临床应用赵氏人工气管远期结果，介绍手术适应证及技术要点。方法回顾性分析3例气管腺样囊性癌、4例良性疾病（3例为外伤后气管缺损）气管大段切除后赵氏人工气管重建术者转归。良性者就医时均已做过气管切开，2例近端气管闭锁，不能说话。气管切除长度5．5-8．0cm，人工气管长度3．0—4．5cm。分两期手术，用整形外科技术制备成内面为皮肤，外面为颈阔肌，中间夹有记忆合金网，即带血供的肌肉血管蒂的“三明治式”人工气管，用以重建气管缺损。结果2例术后带气管插管5d，5例麻醉清醒后即拔除气管插管，正常呼吸、说话。术后第1d即可下床活动，正常进食。3例恶性病人，1例住院期间死于气管一无名动脉瘘并发症，2例术后1年半分别死于急性肺动脉栓塞和肿瘤广泛转移。4例良性者均已术后3—5年，正常生活工作。结论赵氏人工气管设计合理，材料符合解剖和生理要求，只要手术操作细致，可以成功重建超过气管长度1／2的大段气管缺损。适用于气管恶性肿瘤和良性疾病的气管切除与重建。

Objective To report the long-term results of clinical application of ZHAO＇ s artificial trachea. Introduce the indication and technieal key point. Methods Seven patients undergoing long-segment resection of trachea received tracheal reconstruction with ZHAO＇s artificial tracbes. There were 3 cystoid adenocarcinomas and 4 benign cases including 3 trauma patients. Four benign patients had tracheostomy before admission; two of them with closed upper trachea lost the ability of speech. The length of tracheal defeet were 5.5 - 8.0 can, the length of artificial trachea were 3.0 - 4.5 cm. Reconstruction procedure was two-staged. With plastic surgery technique, a ＂sandwich＂ pedicle artificial trachea was made, of which the inner surface was skin, outer covering was platysma, a memory-alloy mesh was in between. Results Two patients required intubation for 5 days. Five patients could speak normally, wald around and have normal food in first postoperative day. Three malignant patients died. One died from tracheo-innominate arterial fistular, 2 died from acute pulmonary embolism and systemic malignancy 1.5 year later. Four benign patients survived 3 - 5 years with normal life and word. Conclusion The design of ZHAO＇s artificial trachea is practicable. The artificial material comparatively copes with tracheal anatomy and physiology. It is an alternative choice for tracheal reconstruction after more than half length long-segment resection. It is suitable for both malignancy and binign condition.