气管疾病外科临床治疗体会

Clinical experience on surgical treatment of tracheal diseases

目的探讨气管疾病外科治疗的临床特点和治疗策略。方法回顾性分析2003年1月—2007年3月上海交通大学附属胸科医院胸外科收治的42例气管疾病患者的临床资料。结果气管良性病变18例,恶性肿瘤24例。良性病变中以气管切开术后狭窄(10例)为主。恶性肿瘤的组织类型主要为腺样囊性癌(10例)和鳞癌(7例)。手术切除重建气道38例,姑息性支架置入术4例。38例手术患者均安全度过麻醉和手术期,除2例于术后1个月内死亡外,其余患者均顺利出院。随访期间,18例气管恶性病变患者中,1例于术后4个月出现多发颅内转移死亡,6例患者已存活3年以上。非手术治疗的4例患者均于术后1年内因肿瘤浸润转移而死亡,最长存活时间为6个月。结论气管肿瘤和良性狭窄的治疗首选气管切除重建术,术前应谨慎评估病情,采用合适的手术方式能达到较好的治疗效果。气管支架置入可作为姑息性治疗的补充治疗手段。

Objective To discuss the clinical features and surgical managements of tracheal diseases. Methods The clinical data of 42 patients with tracheal diseases, who were treated in our department between January 2003 and March 2007, were analyzed retrospectively. Results The 42 patients included 18 with benign lesions and 24 with malignant tumors of trachea. The main cause of benign lesions was tracheal stenosis owing to postintubational injury （n = 10）; the most common histological findings for malignant tumor were adenoid cystic carcinoma （n= 10）, followed by squamous cell carcinoma （n= 7）. Thirty-eight cases underwent surgical operation for tracheal resection and reconstruction and 4 received trachea stent as a palliative therapy. Two cases died in the first month after operation. During follow-up, months later due to intracranial metastasis and 6 patients among the 18 patients with malignant tumors, 1 died 4 have survived for over 3 years. The 4 patients received non-surgical treatment all died within 1 year after operation, with a longest survival time of 6 months. Conclusion Surgical trachea resection and reconstruction are the first choice for tracheal diseases like benign lesions and malignant tumors. Careful assessment of disease together with appropriate surgical technique according to the lesion leads to satisfactory outcomes. Tracheal stent may serve as a palliative therapy in cases unsuitable for surgery. （Shanghai Med J, 2009, 32：611-613）