炭纤维复合材料人工气管的临床应用

知１９９０年３月开始，将自制的炭纤维复合材料人工气管应用于所管恶性肿瘤２例，外伤性狭窄１例，共３例，均取得了良好效果，首例随访４年５个月，情况良好。对人工所管应用的适应证，人工气管材料的选择和手术方法进行了讨论。     

人工胸骨修补胸骨缺损

１９９４年５月至１９９７年８月，我们选用多孔有机玻璃（聚甲基丙烯酸甲酯，ｐｏｌｙｍｅｔｈｙｌｍｅｔｈａｅｒｌａｔｅ）自制成人工胸骨修补胸骨缺损５例，效果满意，现报告如下。临床资料　本组５例均为男性，年龄４０～６０岁。其中胸骨浆细胞性骨髓瘤３例，胸骨柄血管内皮肉瘤１例，胸骨柄转移性低分化鳞癌１例。全组均在气管插管、全麻下手术。胸骨正中切口，游离皮肤及正常皮下组织至肿瘤缘外３．０ｃｍ。彻底切除肿瘤及周围组织，应用多孔有机玻璃（孔直径３ｍｍ或５ｍｍ）按缺损大小制成人工胸骨修复缺损区，用钛丝将作者单位…     

气管隆突切除及重建术治疗中心型支气管肺癌

本文报告１０例侵及气管隆突或距隆突０．３ｃｍ以内的中心型支气管肺癌行气管隆突切除及重建术，其中右上叶及隆突切除重建术３例，右全肺及隆突切除２例，左全肺及隆突切除４例，左上叶及隆突切除重建术１例，加部分左心房切除术３例。本组根治切除９例。姑息切除１例。术后并发症３例（３０％）。术后无癌生存６年１例，３年１例，２年１０月１例，２年６月３例，１年２例，半年１例；另１例于术后８月死于脑转移。重点讨论了手术适应证、手术方法、围手术期监护和处理。     

人工气管置换术2例

报告２例广泛型气管癌切除气管、行人工气管重建的手术经验。选用人工气管截面面积为气管的５０．８７％，长度为切除气管的６６．７％。临床实践表明，正确选择人工气管的内径和长度是建立排痰机制的关键。２例病人随访１６～２７个月，未发现与人工气管有关的并发症。     

2例人工气管置换术的护理

人工气管置换术是近年来开展的新技术。气管由于炎症、肿瘤、损伤等疾患需要气管切除和气道再建。当气管切除，端端不能吻合的情况下须行人工气管置换术。人工气管主要适用于气管切除长度超过5．0cm者，切除长度虽然小于5．0cm，但气管与周围组织粘连无法分离者，气管壁部分切除者［1］。我科1990年和1994年先后为2例患者行人工气管置换术，效果良好，现介绍如下。1病例介绍例1，女，39岁。因咳嗽，呼吸困难，经抗生素治疗无好转6个月，近3周呼吸困难加重，不能平卧，于1990年3月18日入院。查体：患者呈吸气性呼吸困难，三凹征（＋），口唇…     

气管内插管全麻后并发症6例分析

本院于１９９６年１月至２０００年１２月，行气管内插管全麻共３５８２例，其中出现并发症６例，占同期全麻总数的０．１７％。现分析如下。临床资料本组共６例，其中男４例，女２例；年龄４４～７０岁。手术种类：胃切除术３例，肾切除术１例，脾切除术１例，胆囊切除肠松解术１例。麻醉方法：单纯气管插管全麻（GA）４例，气管内插管全麻＋硬膜外阻滞（GA＋TEA）２例。并发症出现于气管导管拔管后１小时内３例，１２小时后３例。除１例已送至病房未及时发现，致心跳骤停而脑死亡外，其余５例均病愈出院。具体情况见下页表１。讨论１．…     

小儿气管异物的麻醉处理：附70例报告

小儿气管异物的麻醉处理（附７０例报告）周国斌，杨来宾，陈志明，林派冲我院于１９８８年６月～１９９２年３月期间在直接喉镜或气管镜下行小儿气管异物取出术７０例。术前用药东莨菪碱０．０１ｍｇ·ｋｇ（－１）。根据不同麻醉用药分为五组：Ｉ组，３２例，年龄１．６...     

胸腺切除治疗重症肌无力34例体会

自１９８０年４月至１９９５年９月，采用胸腺切除治疗重症肌无力３４例，年龄５～６２岁，术后早期死亡１例，死亡率２．９４％，３３例随访３个月至１２年，１年内缓解和改善率为８７．９％（２９／３３），１～３年缓解和改善率为８８．５％（２３／２６），３年以上缓解和改善率为８０．０％（４／５）。随访结果表明胸腺切除治疗重症无 力效果满意，延迟拔除气管插管或早期行气管切开术，是防治术后重症肌无力危象的有效措施。     

加温雾化器在人工气道中的应用

人工气道病人，上呼吸道生理性湿化加温功能明显降低甚至消失，造成气管腔内分泌物干燥粘结，阻塞气道，影响正常通气，引起肺部感染［１］。我院１９９５年７月至１９９８年７月对１８２例人工气道病人施行了持续加温雾化，现总结报告如下。１　资料与方法１．１　资料：１８２例病人中，男１０４例，女７８例，年龄最大７２岁，最小２岁，平均（４１．３７±１．５４）岁。气管插管８９例、气管切开９３例，为脑血管意外、大手术后（肺、食管、腹部、体外循环）、呼吸衰竭、肺部感染等需留置人工气道维持供氧和排痰的非呼吸支持病人，留置…     

胸部疑难疾病的纵隔镜检查

为探讨纵隔镜检查术在胸部疑难疾病诊断上的作用，１９９２年１０月至１９９５年９月对３５例胸部疑难病例施行全麻下的纵隔镜检查术。经气管间隙人工隧道观察气管周围肿物和淋巴结并进行活检。结果显示，总确诊率为８５．７１％。左肺癌判断右侧纵隔淋巴结是否转移的敏感性为１００％。仅临床诊断的病例检查后的病理确诊率为８０％，其中良性病变比率占４８％。位于气管前、气管旁、气管支气管拐角区、隆凸下的病变，纵隔镜检查的确诊率大于８５％，位于气管后、前纵隔及距气管较远的纵隔其他部位为纵隔检查的盲区。病变直径＜３ｃｍ者病理确诊率９２．３１％，＞３ｃｍ的确诊率６６．６７％。１例并发颈部切口感染，发生率２．８６％。总之，纵隔镜检查阳性率与病变部位有关（Ｐ＝０．０１２９），而与病变大小无关（Ｐ＝０．１６６１）。胸部疑难病例最常见的误诊病种是结核病和结节病，故试验性放、化疗的习惯作法需慎重。     

聚酯聚丙烯复合人工气管重建气管的实验研究

探讨微孔孔聚酯聚丙烯复合人工气管重建气管的效果。方法：将１７只犬分成２组,在手术切除术部分颈段气管后,Ⅰ组（１２只）用６ｃｍ长的人工气管作置换,采用可吸收性合成缝线吻合１１只,用聚丙烯缝线吻合１只。Ⅱ组用４ｃｍ长的人工气管作置换,其中３只用ｍａｘｏｎ缝线吻合,２只用ｐｒｏｌｅｎｅ缝线吻合。     

An experimental study of successful tracheal replacement using pedicled latissimus dorsi muscle flap and soft Marlex mesh

The present experimental study was undertaken to evaluate the efficacy of combined latissimus dorsi muscle flap and soft Marlex mesh in the reconstruction of the trachea. Thirty-one mongrel dogs underwent a two-stage operation. In the first stage operation, they were divided into four groups for implanting a different prosthesis. A silicone rod was used as the core and this was rolled with soft Marlex mesh to make a prosthesis (Group A and B: without reinforce, Group C: reinforced by wrapping stainless steel mesh, Group D: reinforced with helical stain steel wire). The latissimus dorsi muscle flap was rolled circumferentially around the prosthesis and it was left in place for a period of 4 to 6 weeks. In the second stage operation, the long pedicled muscle flap with the biologically organized prosthesis was mobilized to be guided into the cervix, and the tracheal reconstruction was done with them following circumferential tracheal resection. In result, five of six dogs of group D survived more than 6 months after the replacement without anastomotic leakage or stenosis causing inflammatory granulation. Organization with neo-vascularity of the prosthesis at the time of the tracheal reconstruction was important firstly to avoid incurring complications concerning anastomosis and secondly for long-term stability of the healing and epithelialization of the prosthesis.     

用肺组织瓣重建胸段气管的动物实验与临床应用

目的 探讨用肺组织瓣重建胸段气管的可行性。方法 健康犬15只,切除其长6～8个气管软骨环、周径1／2以上的气管前、后壁,内置镍钛合金网架。游离邻近带血管蒂的肺组织瓣,缝合修补气管壁之缺损。分别于术后2～12个月处死动物,观察气管缺损部位的修复情况,并取材行光学显微镜及电镜检察。临床上用此方法治疗4例患者,其中1例右主支气管因瘢痕狭窄闭锁,1例主气管下段混合瘤恶变,2例左主支气管类癌。结果 实验犬呼吸道通畅、无狭窄及肉芽组织形成,用于修复的肺组织瓣和金属网架表面覆盖有较完整的假复层纤毛柱状上皮。临床治疗的4例患者,均顺利恢复正常呼吸功能,随访疗效稳定。结论 肺组织瓣是较理想的胸段气管重建材料。     

人工气管重建气管的实验研究

目的研制一种新型的人工气管假体，构建犬气管长段环行缺损与重建动物模型。方法实验犬16只，以3种不同类型的人工气管进行颈段气管重建。通过纤维支气管镜、影像学、病理组织学等检查来评价假体置换效果，筛选出最优化人工气管类型。结果Ⅰ型人工气管组(8只犬)中除1只术后96d出现假体移位，1只术后45d出现切口感染、吻合口瘘外，其余均能长期存活(1只术后90d处死，余均生存达180d处死)。术后假体通畅度良好，与宿主气管及其周围组织融合生长达到了生物学固定。假体内腔可见不规则的黏膜上皮生长。假体周围包绕的组织中可见散在的大小不等的新骨形成。Ⅰ型人工气管在普通X线下可以显影。Ⅱ型人工气管对照组(4只)术后均出现不同程度的假体移位、吻合口炎性肉芽肿增生和管腔狭窄等并发症。Ⅲ型人工气管对照组(4只)术后生存时间均未超过1个月，主要死亡原因为来自假体本身的网管裸露、漏气、感染和塌陷。结论Ⅰ型人工气管是一种复合式结构，糅合了无孔型和有孔型人工气管的优点，基本具备了置换和替代气管缺损的重要条件，对进一步应用于临床气管重建领域的研究具有重要的参考价值。     

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。     

高分子聚合物材料人工气管移植的实验研究

目的：通过材料筛选和编织成型工艺制备一种新型的人工气管假体,构建犬颈段气管缺损与重建的实验动物模型。方法：模拟气管解剖结构和几何形状,用聚丙烯和聚乙丙交酯纤维整体编织成网状直形管作为基本支架,根据涂层材料和涂层方法的不同制成3种类型人工气管,(1)Ⅰ型人工气管：网管内壁依次涂聚氨酯和胶原蛋白溶液封闭网管内壁网孔,外壁覆盖胶原蛋白-羟基磷灰石微孔状海绵层;(2)Ⅱ型人工气管：网管内外壁均涂聚氨酯;(3)Ⅲ型人工气管：网管内外壁仅涂胶原蛋白溶液。采用Ⅰ、Ⅱ、Ⅲ型人工气管分别对8、4、4只犬行人工气管移植术,于术后30、90、180d行纤维支气管镜、X线摄片及CT扫描检查,术后180d处死全部动物,组织标本行病理及电镜观察。结果：(1)移植Ⅰ型人工气管犬,5只存活至180d处死,3只犬分别因切口感染与吻合口瘘、假体滑脱及实验原因于术后45、96、90d死亡。处死犬假体与宿主气管及周围组织融为一体,纤维支气管镜检查示气管黏膜上皮不同程度地越过上、下吻合口向假体内腔中央汇合,新生的上皮为假复层纤毛柱状上皮,有纤毛超微结构。x线摄片和CT扫描示人工气管显影清晰,无移位、通畅良好,假体周围组织中散在分布大小不等的新骨。(2)移植Ⅱ型人工气管犬,术后均出现不同程度的假体移位、吻合口肉芽肿增生和管腔狭窄等并发症。(3)移植Ⅲ型人工气管犬,生存时间均未超过30d,主要死因为假体本身的网管裸露、感染、漏气和塌陷。结论：Ⅰ型人工气管兼具无孔型和有孔型人工气管的优点,基本具备了置换和替代长段气管缺损的重要条件。     

A silicone prosthesis for covering a large tracheal defect in patients who underwent surgery for locally recurrent aggressive thyroid cancer

Following the usual sleeve or windowresection of the trachea, reconstruction of the trachea can be carried out without difficulty in patients with aggressive thyroid cancer. When the cancer recurs locally in those patients, reoperation often yields a large tracheal defect, for which a commercially available tracheostomy cannula or a silicone-tube does not fit. By using a technique in the maxillofacial prosthetic field, it has become possible to make a new type of prosthesis which is more comfortable and acceptable to the patients with a large tracheal defect. A new type of silicone rubber prosthesis is made individually from the mold of each patient. Several appointments are required for adjustments by the chair side. It must tightly obstruct the tracheostomy stoma so that the patient can easily breathe, speak and take oral fluids. Patients can easily remove and replace this device by themselves and care of the prosthesis is easy. The practical use of this type of prosthesis in three patients is reported herein.This paper was presented at the Toronto meeting of the International Association of Endocrine Surgeons in 1989     

Primary tracheal tumors: experience with 14 resected patients.

OBJECTIVE: Primary tracheal tumors are rare. Management includes interventional endoscopy, surgery and radiotherapy. METHODS: Between 1987 and 1996, 14 patients treated by resection and reconstruction of the trachea and bifurcation for primary tracheal tumors were retrospectively analyzed. RESULTS: The most common histological finding was adenoid cystic carcinoma (n=7), followed by a squamous cell carcinoma (n=2), a mucoepidermoid carcinoma (n=2), a carcinoid tumor (n=1) and two benign tumors (xanthogranuloma, pleomorphic adenoma). Various reconstruction techniques were used and one prosthesis was implanted. Eight of the patients required preoperative Nd-YAG laser recanalisation. Six were treated by postoperative external beam radiotherapy, in three cases combined with endoluminal brachytherapy. Two major postoperative wound-healing impairment at the anastomosis occurred. Four minor wound-healing disorders were successfully treated by interventional endoscopy. Two patients died postoperatively with mediastinitis respectively with bilateral pneumonia. A local recurrence was observed in only two cases. At the last follow-up in January 1998, nine patients were still alive. We observed five long-term survivors (>6 years) with an adenoid cystic carcinoma or mucoepidermoid carcinoma. CONCLUSIONS: Extensive segmental resection of the trachea is the treatment of choice for primary malignant and occasionally for benign tracheal tumors. Interventional endoscopy is a part of modern tracheal surgery.     

Survival analysis of rats implanted with porous titanium tracheal prosthesis

Background. Surgical treatment of a malignancy in the trachea may lead to a long resection that has to be reconstructed with an artificial prosthesis. However, most of the available prostheses encounter inflammatory rejection and mechanical constraint problems. To improve tracheal rehabilitation a porous titanium prosthesis was developed. The aim of this study was to test the biocompatibility of this novel material.

Results. Fibroblast colonization of titanium pores and a ciliary cylindrical epithelial layer developed on the endoluminal side of the prosthesis and the inflammatory reaction was minimal.

Conclusions. The results of this short-term study validate, from surgical and histologic standpoints, the usefulness of a porous titanium tracheal prosthesis.     

Prosthetic reconstruction of the trachea in rabbit

BACKGROUND: Various tracheal reconstruction techniques have been developed for stenosis. Different types of grafts, flaps and synthetic materials have been used for reconstruction of the defect when primary anastomosis was unsuccessful or not indicated. The mentioned reconstruction methods have limited success. Polytetrafluoro-ethylene (PTFE) prosthesis is a microporous polymer and has been applied for implantation on a wide range. It is also appropriate for tracheal reconstruction. METHODS: In the present study, segmental defects were created in 12 New Zealand rabbits. The rabbits were divided into 2 subgroups; the first group was applied an end-to-end anastomosis whilst the second a PTFE prosthesis. After 2 months, these applications were compared clinically, endoscopically and histopathologically to each other. RESULTS: Necrosis and extrusion were not observed in the rabbits with PTFE applications. After 1 month, the tracheal stenosis was found on endoscopic examination in 5 animals in the first group and 2 animals in the second group. While in longer defects, end-to-end anastomosis causes tracheal tension, PTFE applications have been well tolerated. CONCLUSIONS: It is concluded that PTFE prosthesis is a suitable alternative method in reconstruction of circumferential tracheal defects.