记忆合金网二期成形人工气管实验研究

目的寻找一种能与自体气管完全愈合为一体的人工气管。方法将20只犬随机分为带蒂组和不带蒂组，经二期手术成形制成“三明治”式人工气管。置换6cm长颈部气管，观察其生存期、吻合口有无狭窄等。结果带蒂组术后除1只出现吻合口狭窄，2只出现吻合口感染外，其余7只生活质量好。不带蒂组犬术后4周内全部死于吻合口狭窄和感染。结论带蒂记忆合金网二期成形人工气管基本可与自体气管融为一体．成为自体气管的一部分。此种人工气管可以应用到临床。     

记忆合金网二期成形人工气管置换术

目的 探讨能与自体气管完全愈合为一体的人工气管的制备方法。方法 应用记忆合金网二期手术成形制成人工气管,经过2年的动物实验后,应用于临床,为1例复发性气管类癌,重建了气管。结果 这种外带有肌肉血管蒂,内面为皮肤复盖替代了气管上皮的“三明治式”人工气管,上下端吻合口与自体气管完全愈合,结合为一体,完全符合气管的生理机能。手术1次成功,无并发症,术后随访6个月,患者生活劳动正常。结论 “三明治式”记忆合金网二期手术成形带蒂人工气管能与自体气管紧密愈合并完全融为一体。这种气管内面复盖自体皮肤,没有排异、血供丰富、易于存活。     

Experimental replacement of the trachea by dacron-silicone rubber prosthesis

Experimental results of trachea replacement by dacron-silicone rubber tube in rabbits and dogs were presented. The techniques for anastomosis of the prosthesis to the host trachea, prevention of obstruction by granulation and the dynamic effects of air current during cough reflex caused by the artificial trachea were also investigated. Experiments showed that the use of artificial trachea with right size (inner diameter) was the key to maintain expectoration mechanism. When the artificial trachea was constructed on proper selected cases, complications resulting from use of Nevilles are preventable.     

Re-epithelialization after laser therapy of a stenotic artificial tracheal graft: A pilot experimental study

Tracheal reconstruction is a challenging field of research for thoracic surgeons. Recent tracheal grafting studies report short observation times, which make it difficult to conclusively evaluate efficacy. Long-term studies examining the durability of artificial trachea strategies are needed. An ideal artificial trachea strategy would allow for no intervention following replacement, but this approach is presently infeasible. Today, interventional bronchoscopic techniques are widely accepted as a follow-up to airway problems after surgery. Our laboratory developed a semiconductor laser method for endobronchial treatment of stenotic implanted artificial trachea grafts. We herein report the results of a pilot study testing the endobronchial laser treatment in a canine model. The laser treatment yielded vigorous airway re-epithelialization on the graft from the native trachea.     

A case of post-radiation therapy patient with difficulty in intubation unexpected preoperatively

We experienced a post-radiation therapy patient who had a narrow trachea, and presented with unexpected difficulty for intubation. His trachea was narrowest at 2 cm below the glottis. The fiberscope barely could pass the narrowest part of the trachea. We speculate that the radiation therapy induced his tracheal constriction. Careful attention is necessary when examining the post-radiation therapy patients. Multiple cervical radiographs are necessary in such a case.     

组织工程气管研究进展

气管切除超过原长度的一半时便需要一个人工气管以进行安全的重建.本文就组织工程化气管构建的研究进展进行了综述,并指出组织工程化气管研究领域所面临的问题和今后的研究方向.     

Resection of thyroid carcinoma infiltrating the trachea.

We have treated surgically 11 patients with thyroid carcinoma that had infiltrated into the trachea. Three patients had primary tumours, and eight had recurrent tumours after previous operations. Sleeve resection of trachea was performed where thyroid carcinoma had proliferated; the trachea was reconstructed by end-to-end anastomosis. In two patients 10 rings of the trachea were resected. In three patients the anterior half of the cricoid cartilage was resected along with the cervical trachea. In one patient tracheoplasty was performed using partial extracorporeal circulation because severe tracheal stenosis prevented endotracheal intubation. Two of the 11 patients died from the surgery and one from disseminated metastases. One patient who had undergone tracheal resection for thyroid carcinoma three years and five months previously had a recurrence of the tumour in the trachea adjacent to the anastomosis, and a second tracheal resection was performed. In three patients postoperative laryngeal stenosis occurred. Five patients are alive and well two years and one month to four years and seven months after their operations. The histological pattern of the tumour was papillary adenocarcinoma in all 11 patients.     

赵氏Ⅱ型人工气管实验研究

目的 探索一种不必分期手术而且能与自体气管达到生物性愈合的人工气管.方法 用长5cm羊气管,经过0.625%戊二醛处理后,腔内缝置长6 cm Sigma不锈钢丝支架,制成赵氏Ⅱ型人工气管.实验时切除羊颈段气管5 cm,用人工气管重建.手术后1、2周、1、3、6及12个月拍颈部X线片、行支气管镜检查,然后处死实验动物检查大体和镜下病理,观察人工气管愈合情况.结果 6只实验动物人工气管与自体气管均顺利达到生物性愈合,黏膜成活,实验动物长期存活.3个月时有部分软骨细胞融解吸收,但支架位置良好,管腔通畅.6及12个月后标本显示人工气管完全成活,但吻合口处有少量肉芽增生,管腔轻度狭窄.结论 赵氏Ⅱ型人工气管可以与自体气管形成生物性愈合,并能够长期保证气道管腔通畅,此为临床大段气管缺损的重建提供了一种较好方法.     

Successful resection of a glomus tumor of the trachea

Extracutaneous glomus tumors are uncommon, and their occurrence in the trachea is rare. We present a case of a surgically resected glomus tumor of the trachea in a 56-year-old woman who presented with worsening dyspnea and cough. Bronchoscopy and computed tomography showed a polypoid tumor arising from the posterior membrane of the lower trachea just above the carina; the tracheal lumen was approximately 80% occluded. The patient underwent successful tracheal sleeve resection with primary reconstruction. The histological characteristics and immunohistochemical profile were typical for this tumor. The clinicopathological features of this unusual neoplasm are discussed, and the literature is reviewed.     

Endoscopic intubation of the trachea in emergencies

The article presents the results of performing endoscopic intubation of the trachea under emergency situations in patients and victims of traumatic and pyo-inflammatory alterations of organs and tissue of the neck. The technique of the trachea intubation is described. It was noted that in such patients there appear serious problems during the intubation of the trachea by the method of direct laryngoscopy which are due to considerable disturbances of the anatomo-topographic interrelations of the organs, marked edema of the tissues and by the presence of the pathological content in the lumen of the oro- and laryngopharynx. The trachea intubation performed under the control of vision with the help of a bronchofibroscope allows to avoid additional traumatization of the tissue of the oro- and laryngopharynx, to rapidly introduce the endotracheal tube into the trachea without hypoxia, to perform sanitation of the oral cavity, pharynx and the tracheobronchial tree.     

同种异体气管移植一例

目的 利用同种异体气管移植治疗病变长度超过５ｃｍ的气管疾病。方法 １９９９年３月１７日为１例喉癌复发患者行全喉和气管中上段切除８ｃｍ,供体气管长约６ｃｍ,经体外灭蓖和除抗原处理１６８ｈ后,用５．５ｃｍ一端与气管在隆突上３ｃｍ处吻合,另一端与胸骨上皮肤及胸大肌皮瓣作吻合作气管外品,用带蒂胸大肌皮瓣和带蒂大网膜包裹供体气管解决血供。结果 气管内吻合口生长良好,２６ｄ起供体气管内粘膜开始被自体气管内粘膜     

Clinicopathologic study on the mode and degree of invasion of the trachea by thyroid carcinoma

Among 23 patients with thyroid carcinoma infiltrating to the trachea, total 7 laryngectomy and 16 tracheal resection were carried out, associated with thyroidectomy and neck dissection. The infiltrating mode and degree to the trachea in these patients were classified into 2 types according to the anatomical characteristics: Types of cartilage and membranous portions. Moreover, the former was further subclassified into 3 divisions. The subtype I of cartilage portion: Infiltration to the adventitia of trachea. Histologically, there were 3 well differentiated carcinoma, 3 poorly differentiated carcinoma and one medullary carcinoma. The prognosis was favorable comparing to other types. All 7 patients are alive. The subtype II or III of cartilage portion: Infiltration to the cartilage or annular ligament of trachea. Poorly differentiated carcinoma were noted in 6 of 7 patients. Five are alive and 2 died. The membranous type: Infiltration to the membranous portion of trachea. Esophageal invasion was noted in 7 patients. Undifferentiated carcinomas and squamous cell carcinoma took over a half of the patients. Two are alive and 7 died. The prognosis was the worst.     

Slide tracheoplasty for congenital funnel-shaped tracheal stenosis

Congenital funnel-shaped trachea is a serious condition, and the survival rate in infants is poor. A slide tracheoplasty is described, with a brief review of other methods of repair. Two cases that demonstrate the operability of congenital funnel-shaped trachea in infancy are reported.     

An experimental study on viability of the devascularized trachea

This experiment was designed to evaluate the effect of varying extents of devascularization to the viability of the trachea, and the influence of preservation of the right bronchial artery on the ischemia of the widely devascularized trachea. In experiment 1, the canine trachea was devascularized in a stepwise manner, and the regional blood flow was measured in each situation. This experiment revealed that the regional blood flow decreased to one-third of the non-treated trachea when the bilateral bronchial arteries were transected, and to nil when the cervical and mediastinal trachea was devascularized. In experiment 2, in which dogs were divided into 2 groups depending on preservation of the right bronchial artery, the trachea was stepwisely devascularized and the regional blood flow measured. This experiment indicated that the regional blood flow in the trachea when the right bronchial artery was preserved did not so remarkably diminish, though the cervical and mediastinal trachea was devascularized. In experiment 3, dogs were divided into 3 groups according to the extent of devascularization of the trachea and to the presence or absence of the preserved right bronchial artery, and were followed for 2 months postoperatively. This experiment demonstrated that the preservation of the right bronchial artery prevented tracheal necrosis caused by devascularization of the cervical and mediastinal trachea. We concluded that the regional tracheal blood flow markedly decreased and that tracheal necrosis occurred following devascularization of the cervical and mediastinal trachea when the bilateral bronchial arteries were transected. The preservation of the right bronchial artery however, prevented a decrease in the regional blood flow and necrosis of the widely devascularized trachea.     

An experimental study on viability of the devascularized trachea

This experiment was designed to evaluate the effect of varying extents of devascularization to the viability of the trachea, and the influence of preservation of the right bronchial artery on the ischemia of the widely devascularized trachea. In experiment 1, the canine trachea was devascularized in a stepwise manner, and the regional blood flow was measured in each situation. This experiment revealed that the regional blood flow decreased to one-third of the non-treated trachea when the bilateral bronchial arteries were transected, and to nil when the cervical and mediastinal trachea was devascularized. In experiment 2, in which dogs were divided into 2 groups depending on preservation of the right bronchial artery, the trachea was stepwisely devascularized and the regional blood flow measured. This experiment indicated that the regional blood flow in the trachea when the right bronchial artery was preserved did not so remarkably diminish, though the cervical and mediastinal trachea was devascularized. In experiment 3, dogs were divided into 3 groups according to the extent of devascularization of the trachea and to the presence or absence of the preserved right bronchial artery, and were followed for 2 months postoperatively. This experiment demonstrated that the preservation of the right bronchial artery prevented tracheal necrosis caused by devascularization of the cervical and mediastinal trachea. We concluded that the regional tracheal blood flow markedly decreased and that tracheal necrosis occurred following devascularization of the cervical and mediastinal trachea when the bilateral arteries were transected. The preservation of the right bronchial artery however, prevented a decrease in the regional blood flow and necrosis of the widely devascularized trachea.     

Chondrosarcoma Originating From the Trachea

We report a tracheal chondrosarcoma in a 54-year-old man, treated with neodymium:yttrium-aluminum garnet laser vaporization via fiberoptic bronchoscopy followed by surgical resection. Chondrosarcomas of the trachea are extremely rare tumors. To our knowledge, there are 9 cases of chondrosarcoma of the trachea reported in the English-language literature, to which we add the tenth.     

气管切除与人工气管重建手术25例麻醉方法分析

目的 分析讨论气管切除吻合或人工气管替代等手术的麻醉方式和结果.方法 对采用不同手术方式治疗的25例气管良、恶性疾病患者的麻醉和手术过程进行了回顾性分析.其中良性疾病患者10例,恶性疾病患者15例.全组患者气管管腔均有不同程度的狭窄,严重者伴有明显呼吸困难.气管病变长度2.0～7.5cm.气管切除最长者8 cm,行一期吻合者14例,行人工气管替代者7例.该组患者采用单纯全身麻醉气管插管者13例,同时行心肺转流者2例;经已有的气管切开行全身麻醉者8例,在局部麻醉下行气管切开后全身麻醉者2例;行高频喷射通气辅助者2例.气管切断后,均需经远端气管或对侧主支气管内插管维持麻醉和通气.结果 全组患者均顺利完成手术,无麻醉和手术死亡.2例患者于气管切开后向左主支气管插管困难,1例患者向左主支气管插管过深,仅余左下肺通气,造成血氧饱和度下降;1例患者术毕改换无气囊导管时造成吻合口裂开;均经处理后好转.结论 气管手术麻醉风险高,个性化、周密的麻醉和手术方案以及麻醉医师与手术医师的密切配合,是保证麻醉和手术安全的关键.     

双腔支气管导管插管错位原因的影像学分析

目的 探讨双腔支气管导管插管不能进入对应支气管的原因和解决办法.方法 选取87例开胸手术需行双腔支气管导管插管进行双肺隔离通气病例.对每例预设和改变的双腔支气管导管型号、气管及支气管内径和走行情况、双腔支气管导管插管定位情况、气管内镜使用情况及所见、特殊情况等,结合CT所见进行分析.测如下数据:左支气管内径(ZN),右支气管内径(YN),左支气管与气管下半段轴线的夹角(ZJ),右支气管与气管下半段轴线的夹角(YJ),气管下半段轴线与身体纵轴夹角(QJ),右左支气管开口垂直直线距离在气管后段内径中的占比(YB、ZB)和其占比差(YB-ZB).结果 87例中27例气管偏移或变异,其中13例有右支气管导管插管顺利倾向定义为特殊右(TY),另14例有左支气管导管插管顺利倾向定义为特殊左(TZ);其余60例气管基本正常,49例选左支气管导管插管顺利定义为正常左(ZZ),11例选右支气管导管插管顺利定义为正常右(ZY).TY与TZ在ZJ、YJ、QJ和YB-ZB间,与ZZ在YJ、QJ和YB-ZB间,与ZY在QJ和YB-ZB间比较,差异有统计学意义(P＜0.05).TY表现为:QJ右倾(8.08±5.94)°;ZJ角度偏向正常高限(47.46±7.28)°;YB-ZB明显大;YN相对其ZN宽,差异无统计学意义(P＞0.05).TZ表现为:ZJ相对较小;YJ相对较大,与TY相比,差异有统计学意义(P＜0.05),与ZZ、ZY相比,差异无统计学意义(P＞0.05).以上因素决定了气管后半段的趋向性,影响着双腔支气管导管插管的走向,双腔支气管导管插管不能进入对应支气管.结论 插管前根据CT定位像中气管后半段趋向性,选择左或右双腔支气管导管插管,是解决双腔支气管导管顺利插入对应支气管的最简捷方法之一.     

Biomechanical properties of adult-excised porcine trachea for tracheal xenotransplantation

Abstract: Background: To investigate and evaluate the biomechanical properties of adult‐excised porcine trachea, thereby providing experimental methods and evidence for biomedical engineering of artificial trachea. Methods: The TY8000 servo‐handle tension test machine was used to measure biomechanical indices, such as bending stiffness, radial pedestal, and stress‐straining. The residual stress and bursting strength of adult‐excised porcine trachea was evaluated. Results: Residual stress was retained in the adult‐excised porcine trachea. The force of radial pedestal was detected as 10 N, when the diameter of a 50‐mm trachea was compressed to 50%. The bursting strength decreased from 180 mmHg of pharyngeal portion to 110 mmHg in tracheal carina. When the trachea flexed forward or either right or left by 50°, tension reached 0.296 to 0.131 N and 0.254 to 0.150 N, respectively. The curve of stress‐straining measured, according to computer data and results, suggested that tension was maintained at a low level at 50% strain. Conclusions: Residual stress was retained in the excised porcine trachea, and the porcine trachea membrane disrupted when pressure in the inner wall increased. The porcine trachea exhibits good radial pedestal force, bending, and elongation properties.     

Complete disruption of cervical trachea,whose distal airways were migrated into the mediastinum

The first case was a 55-year-old man, who suffered by a rope while driving his motor bicycle. On 7th day after injury, tracheotomy was scheduled due to progressive dyspnea. Following intubation of a endotracheal tube, his trachea was ruptured. The second case was a 16-year-old man, who was stabbed his trachea with a sword by his mother. His trachea completely separated following coughing during the examination of bronchoscopy. For 2 cases, we immediately excised their necks for tracheotomy but couldn't find their distal portion of trachea, because they were migrated into the mediastinum. We inserted our finger into the mediastinum for exploration and could draw it back. Both case's postoperative course was uneventful. Whenever cervical trachea is completely separated, tracheal distal end may be pulled down into the mediastinum. We invited new technique of exploration for migrated trachea using our finger.