留植下肺主支气管重建气管的研究

Trachea reconstruction by using inverted mainstem bronchi of lower lobe

目的探讨更具临床应用可行性的气管重建术。方法32条犬，全麻经左或右第四肋进胸，切除气管下段8～15个气管环长度。分别切除上肺（左侧）或中上肺（右侧）、中枢断端缝闭。保留并充分游离下肺及血管，在开口处切断下肺支气管。将主支气管翻转到上纵隔，并将其末梢端与气管上切端吻合，最后再将左或右下肺支气管断端分别与对侧主支气管内侧壁行端例吻合。结果死于手术并发症14条，存活18条，平均生存期685天（1～468天）。结论由于保留了术侧下肺，呼吸功能损失减少，生存质量提高，故本术式更具临床应用可行性。

Objective To investigate the availability of the trachea reconstruction with inverted mainstem bronchi of lower lobe. Method Thirty-two dogs under general anesthesia underwent the thoracic operation through the 4th costa at left or right. The bronchial lines of 8 to 15 were resected. Upper lobe (left) and upper middle lobes (right) were resected, and the central stamps sutured. The lower lobe and its vessels were reserved. The bronchus of lower lobe was out off on the ostium, mainstem bronchus inverted into the upper mediastinum, and the anastomosis of distal stump to the upper stump of trachea made. In the end, anastomosis of the branchus stump of the reserved lower lobe to stuma on medial wall of the opposite bronchus was performed. Result The 14 dogs were died from complications and 18 dogs survived for 68. 5 days in an average of 14 to 468 days. Conclusion Because the lower lobe was reserved, the respiratory function loss was decreased and the survival quality increased, suggesting this procedure was feasible in chlinical practice.