气管袖状切除及端端吻合重建术治疗良恶性气管狭窄的临床分析

Clinical analysis of tracheal sleeve resection and end-to-end anastomosis reconstruction in treatment of benign and malignant tracheal stenosis

目的探讨气管袖状切除及端端吻合重建术在良恶性气管狭窄治疗中的效果并总结临床经验。方法回顾性分析我院2014年8月至2018年1月因气管狭窄行手术治疗的25例患者的临床资料,其中4例患者采用股动静脉插管建立体外循环转流后诱导麻醉,1例行双腔气管插管,20例于病变上方行小导管气管插管,均行病变气管袖状切除及端端吻合重建术。记录患者手术时间、出血量、术后住院时间及术后并发症情况。结果所有患者均顺利完成手术并康复出院,无围术期死亡病例。手术时间为(209.35±77.75)min,出血量为(182.50±236.26)mL,术后住院时间为(13.28±3.42)d。术后1例患者出现吻合口瘘,经过局部加强换药后二期行转肌瓣气管瘘口封堵术愈合;1例患者术后7 d出现气管软化,急诊气管切开,行永久性气管外置术。随访12~36个月,无吻合口狭窄、肿瘤复发转移等并发症发生。结论针对气管狭窄的治疗,气管袖状切除及端端吻合重建术是一种安全、有效的方法,但需要根据患者的呼吸困难情况、气管狭窄部位及程度选择适合的气道建立方法、合理的肿瘤切除长度及缝合重建方法。

Objective To investigate the clinical effect and summarize the experience of tracheal sleeve resection and end-to-end anastomosis reconstruction in the treatment of benign and malignant tracheal stenosis.Methods The clinical data of 25 patients who underwent surgical treatment for tracheal stenosis from August 2014 to January 2018 in our hospital were retrospectively analyzed.Among them,4 patients were treated with femoral arteriovenous intubation to establish cardiopulmonary bypass followed by induction of anesthesia,1 patient underwent double-chamber tracheal intubation,and 20 patients underwent small catheter tracheal intubation above the lesion.All the patients underwent sleeve resection of the diseased tracheal and end-to-end anastomosis reconstruction.The operation time,blood loss,postoperative hospital stay and postoperative complications were recorded.Results All the patients successfully completed the operation and recovered from the hospital.There was no deaths during the perioperative period.The operation time was(209.35±77.75)minutes,the blood loss was(182.50±236.26)mL,and the postoperative hospital stay was(13.28±3.42)days.Postoperative anastomotic fistula occurred in 1 patient.After local strengthening and dressing change,the tracheal fistula was sealed and healed in the second stage.One patient developed tracheomalacia 7 days after the operation,and this patient was treated by emergency tracheotomy and permanent tracheal exteriorization.The posto-perative follow-up was 12 to 36 months,and no anastomotic stenosis,tumor recurrence and metastasis was observed.ConclusionTracheal sleeve resection and end-to-end anastomosis reconstruction is a safe and effective method for the treatment of tracheal stenosis.But it is necessary to select proper airway establishment method,reasonable tumor resection length and suture reconstruction method according to the patient’s dyspnea,the location and degree of tracheal stenosis.