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。     

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.     

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     

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.     

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。     

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.     

Primary mucoepidermoid carcinoma of the trachea in a child

Mucoepidermoid carcinoma of the trachea is a rare tumour, especially in the paediatric population. We report the case of a 9-year-old boy with mucoepidermoid carcinoma of the trachea that was preoperatively diagnosed as an intraluminal polypoid mass arising from the trachea and extending into the right main bronchus. A complete resection of the tumour with reconstruction and end-to-end anastomosis of the trachea was performed. The patient is now, 24 months after surgery, free of disease.     

Pleomorphic adenoma of the trachea

Pleomorphic adenoma in the trachea is very rare. We report the case of a 46-year-old woman who had been treated for asthma for 12?months before the diagnosis of pleomorphic adenoma of the trachea was made. The tumour was defined by fiberoptic bronchoscopy in the mid 1/3 of the trachea obstructing nearly 90?% of the lumen. Through a collar incision and partial sternotomy, 3?cm segment of the trachea was resected and end-to-end anastomosis was performed.     

Diagnosis and management of major tracheobronchial injuries

From 1968 to 1978, 14 patients were treated for major tracheal or bronchial injury. Five injuries resulted from blunt trauma and nine from penetrating injury. Of the 5 patients with injury due to blunt trauma, three had avulsions of the right main bronchus from the trachea. In 2 of them, the injury was associated with stellate tears of the distal trachea and bronchus. The simple avulsion was repaired by a primary anastomosis of the right main bronchus to the distal trachea. For the other 2 patients, treatment consisted of right pneumonectomy. The remaining 2 patients in this group had complete transection of the trachea and underwent primary repair. Of the 9 patients with a penetrating injury, 4 had lacerations of the cervical trachea which were treated with neck exploration and tracheostomy. Three patients with partial transections of the cervical or upper mediastinal trachea were treated by primary closure. The other 2 patients had gunshot wounds to the distal right lateral trachea, which were treated by right thoracotomy and primary closure. There were no deaths, and the subsequent course was generally good in all patients.     

Neglected Hangman's fracture in association with rupture of the trachea.

BACKGROUND CONTEXT: Rupture of the trachea combined with a Hangman's fracture has been reported rarely in the literature. We present a case of a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks, in a 25-year-old woman after a road traffic accident. PURPOSE: To underline the necessity that physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine. STUDY DESIGN: A 24-year-old woman was involved in a head on collision road traffic accident. She has suffered from a rupture of the trachea combined with a type IV Hangman's fracture that remained undiagnosed for 7 weeks. METHODS: Emergency surgical repair of the rupture of the trachea was performed. A halo vest for a total period of 4 months was applied. RESULTS: The patient followed a rehabilitation program, and, at her last visit, 12 months after her injury, had remained asymptomatic. A computed tomography scan of her cervical spine showed union through callous formation, and she had returned to her previous job and recreational activities. CONCLUSIONS: Physicians treating patients with multiple injuries including the trachea and the mediastinum should be aware of the fact that injuries of the trachea can be accompanied by trauma to other contents of the mediastinum and of the cervical spine.     

A case of undifferentiated carcinoma of the thyroid with compression stenosis of the cervical and mediastinal trachea which was dilated by the expandable metallic stents]

The patient was a 64-year-old male with undifferentiated carcinoma of the thyroid which constricted the trachea. The radiation therapy did not reduce the size of the tumor, and did not improve the dyspnea. Bronchoscopy and tomography showed a compression stenosis of the cervical and mediastinal trachea. It was difficult to insert the T-tube because of the large mass of the neck. Therefore, three EMSs were inserted into the stenotic area of the trachea. Immediately after the insertion of the EMSs, the lumen of the trachea was dilated, and the dyspnea was improved. The patient died of the tumor 7 weeks after the insertion of the EMSs. Autopsy showed that the trachea was dilated by EMSs.     

Surgery of tumours in the thoracic portion of the trachea

We have operated on nine patients suffering from benign or malignant tumours in the thoracic portion of the trachea. The main clinical symptom was difficulty in breathing, accompanied in the majority of cases by attacks of asphyxia, cough with mucous phlegm, and haemoptysis. The following operations were performed: circular resection of the trachea with end-to-end anastomosis, thoracic tracheotomy with enucleation of the tumour, fenestral resection with auto-alloplasty of the ensuing defect, piecemeal removal of the tumour through the lumen of the trachea, and intrathoracic tracheotomy with biopsy of the tumour. All patients were discharged after the operation. When giving an anaesthetic during an operation on the thoracic portion of the trachea it is expedient to introduce a tube into the left main bronchus from the right pleural cavity and to exclude the right lung from ventilation. These measures ensure convenience of manipulation of the trachea, unhampered by the presence of a tube. End-to-end anastomosis is the best way to restore the thoracic portion of the trachea after circular resection. The problem of replacing large fenestral defects of the trachea can be solved by auto-alloplasty with thick Marlex, preliminarily overgrown with connective tissue.     

General anaesthesia in a patient with undiagnosed "saber-sheath" trachea

Saber-sheath trachea describes an abnormality in the shape of the trachea caused by underlying disease processes. We present a case of tracheal stenosis in a patient with undiagnosed saber-sheath trachea, in which there was unexpected difficulty in ventilating the lungs despite a good view at laryngoscopy and visually confirmed tracheal intubation.     

Development of a new surgical procedure for repairing tracheobronchomalacia

We have developed a new surgical method for repairing tracheobronchomalacia. In experiments on dogs we tried external fixation of Marlex mesh (Bard Cardiosurgery Division, Bellerica, Mass.) on the trachea. We first made models of tracheomalacia by making fractures or resections in intrathoracic tracheal cartilages and then made an external fixation of Marlex mesh on the malacic segments of the trachea. In 11 dogs Marlex mesh was sutured onto the trachea with absorbable thread. The trachea was firmly supported after 2 to 6 months, compared with three controls in which no external fixation was made. However, mucosal defects associated with ischemia caused by the suture developed in four of the 11. In 13 more dogs Marlex mesh was bonded to the trachea with fibrin glue. After 3 to 8 months the supporting strength of the trachea increased up to the level of the normal trachea. There was no evidence of inflammation or of mucosal defects. Therefore Marlex mesh was applied to a 44-year-old-man who had experienced frequent attacks of cough syncope. After the operation the attacks of cough syncope and collapsing of his airway disappeared completely.     

Extratracheal biodegradable splint to treat life-threatening tracheomalacia

A 9-month-old girl presented with life-threatening acute respiratory failure 1 week after the surgical correction of a double aortic arch, which was due to a severe bulging of the pars membranacea into the lumen of the trachea that produced a complete obstruction of the lower trachea. Under cardiopulmonary bypass, a Y-shaped posterior biodegradable splint was placed behind the trachea and sutured to the posterior trachea, and a simultaneous right aortic arch aortopexy was performed. Thereafter, the child recovered normal respiratory function. Follow-up bronchoscopy showed a posterior dip at the splint level and an asymptomatic persistent posterior compression of the right main bronchus.     

An intrathoracic vagus nerve schwannoma invading the trachea

A patient with a schwannoma of the intrathoracic vagus nerve is presented. The tumor invaded the trachea and caused dyspnea. It was successfully excised by a segmental resection of the trachea with end-to-end anastomosis. This instance of an intrathoracic vagus tumor invading the trachea is, as far as we know, the first reported in the world.     

Radical operation for thyroid carcinoma invading the trachea

We report 12 cases of well-differentiated thyroid carcinoma that invaded the trachea. In all of these cases, we performed a hemithyroidectomy, including the isthmus, with an accompanying neck dissection and resection of the trachea. Six of 12 patients experienced hemoptysis, and a diagnosis of tracheal invasion was made preoperatively in nine patients by tracheal endoscopy and computed tomography. Histologic diagnosis was confirmed by a preoperative biopsy in one case only. An end-to-end anastomosis of the trachea was performed in five patients, an anastomosis between the cricoid cartilage and the trachea was performed in five patients, and an anastomosis between the thyroid cartilage and the trachea was performed in two patients. One patient with a recurrence of tumor died of tracheal bleeding 11/2 years later. One patient died of massive gastrointestinal bleeding postoperatively. The remaining ten patients have been doing well from three months to five years two months postoperatively.     

Anesthetic management of a patient with Saber-sheath trachea]

A 65-year-old man was scheduled for total gastrectomy. Preoperative chest radiograph showed significant narrowing of the trachea. On chest CT scan the trachea was U-shaped (tracheal index = 36%) and was diagnosed as saber-sheath trachea. During general anesthesia we took care to reduce the irritation by the endotracheal tube, particularly during intubation, and to avoid excessively high airway pressure. The trachea was watched carefully by bronchoscopy after intubation and during extubation not to neglect any complication. There was no complication after the operation.