气管袖状切除联合断端一期吻合术在颈段良性气管狭窄患者中的应用分析

The application analysis of tracheal resection combined with primary end-to-end anastomosis in patients with benign cervical tracheal stricture

目的 探讨采用气管袖状切除联合断端一期吻合术治疗颈段良性气管狭窄的疗效及并发症的预防.方法 回顾性分析22例因不同病因所致颈段良性气管狭窄并接受手术治疗患者的临床资料.结果 气管狭窄长度为2.2～4.2 cm.颈段气管狭窄的严重程度：Ⅱ级6例,Ⅲ级11例,Ⅳ级5例.22例患者术后全部顺利拔管,术后出现暂时性声音嘶哑1例,单侧肺不张合并胸腔积液1例,皮下气肿伴切口感染1例,轻度吞咽疼痛及吞咽困难3例,气管吻合口炎性肉芽组织增生3例,10例女性患者中发生暂时性音调变低5例.未出现吻合口瘘或断裂等严重并发症.所有病例随访6～45个月未出现气管再次狭窄致呼吸困难情况.结论 颈段良性气管狭窄行气管袖状切除联合断端一期吻合术治疗成功率高,疗效显著,是安全可靠的治疗方法,术前应谨慎评估和严格把握手术适应证.

Objective To introduce the outcomes of tracheal resection combined with primary end-to-end anastomosis for benign cervical tracheal stenosis,and to discuss the strategy for prevention of surgical complications.Methods The clinical data of 22 patients due to different causes benign cervical tracheal stenosis surgery were analyzed retrospectively.Results The length of cervical tracheal stenosis ranged was 2.2-4.2 cm.Grade Ⅱ stenosis was present in 6 patients.Grade Ⅲ stenosis was present in 11 patients and grade Ⅳ stenosis in 5 patients.Successful extubation was achieved in all 22 cases.After surgery,temporary hoarseness occurred to 1 case;unilateral pulmonary atelectasis with pleural effusion occurred to 1 case; subcutaneous emphysema with infection occurred to 1 case; mild dysphagia occurred to 3 cases;a slight deepening of the tone of voice in 10 patients with women occurred to 5 cases,granulation tissue growth near the suture occurred to 3 cases,and suture dehiscence did not occur in any patient.The follow-up period ranged from 6-45 months,no patient developed restenosis.Conclusions It presents a high success rate and good functional result of tracheal resection combined 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.