气管,支气管肿瘤切除及成形术53例

作者经治肺部肿瘤切除４８５例，其中气管、隆突、主支气管袖状切除及肺叶切除成形术５３例（１０．９％）。良性肿瘤４例（７．６％），恶性肿瘤４９例（９２．４％）。气管袖状切除及隆突切除成形６例，主支气管袖状切除及肺叶切除成形４７例。术后呼吸衰竭死亡１例（１．９％）。五年存活率３５％（６／１７），三年存活率５６％（１８／３２），一年存活率７７．８％（３５／４５）。作者认为本病应重视刺激性咳嗽及痰带血丝的早期症状；早期诊断、早期手术治疗效果良好。气管、支气管袖状切除及肺叶切除成形，扩大了肺部肿瘤切除的手术指征。     

气管隆突主支气管袖式切除治疗中心型肺癌的临床应用研究

目的:总结32例气管隆突、主支气管切除成形手术治疗中心型肺癌妁经验。方法:主支气管袖状切除对端吻合术16例,全隆凸切除重建1例,左全肺切除部分隆突切除重建1例,右上肺叶切除部分隆空切除重建6例、主支气管楔形袖式切除8例。结果:术后21天死亡1例,系吻合口肉芽肿形成,激光治疗后死于肺动脉破裂出血。术后一年生存率89.28％(25/28),三年生存率60.71％(17/28),五年生存率39.28％(1/28)。结论:气管隆突主支气管切除成形手术提高了中心型肺癌的手术切除率,并取得满意的治疗效果。     

支气管袖状肺叶切除肺动脉成形术治疗中央型肺癌

目的总结支气管袖状肺叶切除、肺动脉成形术治疗中央型肺癌的经验。方法 1989年5月至2009年5月,对52例中央型肺癌病人施行以支气管袖状肺叶切除术,部分病人同时行肺动脉成形术。包括支气管环状切除成形及支气管袖状成形肺叶切除术38例;支气管肺动脉双袖状成形肺叶切除术12例;气管隆突及半隆突切除重建合并肺叶切除术2例。结果本组手术死亡1例。发生手术并发症5例次,发生率为9.62%;术后1,3,5和10年存活率分别为52.27%,34.09%,18.18%,4.55%。结论以支气管袖状成形肺叶切除术为核心的多种切除重建术式能最大限度保护病人肺功能,提高了中央型肺癌的治愈率和远期存活率。     

气管,支气管手术围术期气道处理

本文报道１９９１年１月至１９９４年１２月施行的气管，支气管手术５０例，其中，气管环切４例，部分或全隆突切除４例，支气管袖状切除成形４０例，外伤后支气管断端吻合２例，术前肺功能检查，气管狭窄部位定位和程度估测，肺啊包块大小及支气管受累情况，麻醉技术和方法的选择，术中气道保持通畅和充分供氧，术后呼吸监测，小剂量激素应用等是该类手术成功的关键问题。     

气管、隆突及支气管成形术与围术期处理

1980年1月至1997年4月，施行气管、隆突及支气管成形术53例。其中气管成形术3例，隆突切除及楔状切除成形术6例，支气管重建及袖状切除成形术44例。术后无严重并发症及死亡病例。文中对该术式技术要点及围术期处理进行了讨论。     

支气管袖式肺叶切除肺动脉成形术治疗中心型肺癌

目的 总结支气管袖式肺叶切除、肺动脉成形术治疗中心型肺癌的临床经验.方法 回顾分析1989年5月至2009年5月收治的52例中心型肺癌患者,其中38例行支气管环状切除成形及支气管袖式肺叶切除术;12例行支气管肺动脉双袖式肺叶切除术;2例行气管隆突及半隆突切除重建合并肺叶切除术.结果 本组术后死亡1例,发生手术并发症5例...     

气管及其隆突部肿瘤的外科治疗与预后

目的 总结分析气管及其隆突部肿瘤的临床表现、诊断、手术方法以及预后.方法 回顾性分析1986年6月至2005年6月手术治疗的32例气管及其隆突部肿瘤患者的临床资料,其中男性22例,女性10例,年龄14～63岁,中位年龄48岁.32例患者中气管肿瘤切除+端端吻合10例;全肺隆突切除+气管与主支气管端端吻合8例(右侧6例,左侧2例);右上肺隆突袖式切除重建术4例;隆突切除重建术4例;气管开窗行肿瘤及气管壁部分切除6例,其中2例因气管壁切除范围过大,以涤纶布内衬修补.结果 32例中鳞状细胞癌19例,腺样囊腺癌8例,腺癌2例,类癌1例,平滑肌肉瘤1例,腺瘤1例.手术并发症包括术后1例胸腔感染,3例出现心律失常.全组患者无手术死亡.随访时间5个月～3年,随访率100%.Kaplan-Meier法计算1、2和3年生存率为93.7%、59.4%和50.0%.结论 鳞状细胞癌和腺样囊性癌是气管及其隆突部肿瘤最常见的组织类型,术前气管镜和CT可帮助诊断,手术方式的正确选择是提高治疗效果的关键.     

电视硬质气管镜治疗原发性气管支气管肿瘤

目的总结电视硬质气管镜在原发性大气道肿瘤治疗方面的特点及体会。方法2002年9月～2009年10月,电视硬质气管镜手术治疗45例原发性气管支气管肿瘤。平均年龄54.4岁（18～80岁）。病变位于气管29例,隆突4例,左主支气管6例,右主支气管6例。全麻下经口置入电视硬质气管镜,根据病变情况决定治疗方式：窄蒂的良性肿瘤行内镜下完全切除;可切除的肿瘤,内镜下清除肿瘤后开胸行气管支气管部分切除吻合;不能切除的恶性肿瘤,内镜下气道疏通或放置支架。结果全组手术顺利,无死亡及严重并发症。良性病变11例,恶性病变34例。45例共进行49次手术,2例进行了2次手术,1例进行了3次手术。肿瘤根治性切除20次,气道疏通28次,支架放置1次。术后随访平均35.4月（1～83个月）,良性肿瘤中2例腺瘤术后复发,其余9例随访（57.0±22.0）月（5～83个月）无复发;恶性肿瘤中12例腺样囊性癌平均随访28.6月（1～71个月）无复发,其中8例未完全切除患者平均随访19.3月（1～48个月）,均存活;1例气管鳞癌根治性切除者术后随访60个月,存活。26例恶性肿瘤未完全切除者平均随访22.7月（8～41个月）,存活15例（其中复发2例）,死亡11例。结论电视硬质气管镜是原发性气管支气管肿瘤安全、可靠、有效的治疗方法。     

气管主支气管肿瘤手术前后的护理

气管袖状切除成形术及隆突重建术是治疗气管、主支气管肿瘤的重要方法。作者通过１８例气管、主支气管肿瘤切除手术前后的护理，认为：术前耐心、细致的心理护理可以解除病人恐惧心理，使其积极配合手术治疗；给予持续低流量吸氧以纠正缺氧、酸中毒。术后保持正确体位及加强呼吸道管理等是手术治疗成功的关键     

硬质气管镜手术治疗大气道疾病

目的 总结硬质气管镜手术治疗气道良、恶性疾病的效果,探讨其在大气道内疾病治疗方面的价值.方法 2002年9月至2007年11月共为44例大气道疾病患者施行硬质气管镜手术,其中原发性气管肿瘤23例,气管肿瘤术后复发2例,其他病变压迫气管11例,外伤后瘢痕形成4例,异物3例,术后肉芽肿形成1例.窄蒂的良性肿瘤行内镜下完全切除;可切除的肿瘤在硬质气管镜下清除肿瘤后开胸行气管部分切除吻合;不能切除的恶性肿瘤或外压性病变,进行气道疏通或放置支架.结果 病变位于气管19例,隆突4例,左主支气管11例,右主支气管10例.良性病变17例,恶性病变27例.共进行54次手术,其中肿瘤根治性切除17次,气道疏通18次,瘢痕清除8次,异物取出3次,支架放置或取出8次.全组手术顺利,无死亡及严重并发症发生,发生轻微并发症3例.术后良性病变患者随访16例,失访1例,除3例气管外伤后瘢痕形成外,其余13例随访4～44个月,平均23.0个月,均无复发;恶性病变患者随访23例,失访4例,随访时间5～58个月,平均27.1个月,7例根治性切除的恶性肿瘤患者随访均超过1年,仍无瘤生存,无复发;其他患者随访1个月以上,效果满意.结论 硬质气管镜手术治疗大气道内病变安全、可靠,效果确实,值得在临床推广.     

The possibilities of greater omentum usage in thoracic surgery.

OBJECTIVE: To illustrate the wider role of an omental pedicle flap in surgical treatment for diverse thoracic organ disorders we have, retrospectively, reviewed our experience over the last 8 years. METHODS: We used the greater omental pedicle flap in 68 patients. Bronchial stump omentopexy was performed in 35 patients with a high risk of impaired bronchial healing after right pneumonectomy as a preventive method and in two patients with an acute bronchial fistula. In 13 patients after circular tracheal or carinal resections and in four after esophago-respiratory disjoints of fistulas we applied anastomoses or circular omentopexy of the fistula zone. The omental coverage was performed in four patients with chronic empyema, in seven patients after extensive chest wall resection and in two patients with post-sternotomy mediastinites. In one patient with idiopathic fibrosing mediastinitis, one-stage allotransplantation of tracheal thoracic segment was conducted and greater omentum (GO) was used to wrap the allograft. RESULTS: Three patients developed major complications. The first, bronchial fistula after bronchial stump omentoplasty. In two patients circular wide tracheal resection (11-12 rings) was complicated by a tracheal divergence of anastomoses. These complications were cured in a conservative way since a displaced omental flap substituted the tracheal wall and, therefore, the trachea remained hermetically sealed. In other cases, the perfect adhesive properties of the omental tissue promoted perfect adhesive properties promoted prevention of incompetence and inflammatory complications. Immunological and bacteriological examinations showed that pediculated omental flap is a lymphocyte source and promotes a decrease in bacterial quantity and activity. CONCLUSION: We think the series demonstrates the value of the omental method, which offers excellent therapeutic results following an easy surgical procedure. This method extends indications for surgical treatment and decreases the postoperative complications.     

Simultaneous complex single ventricle palliation and tracheoplasty for heterotaxy syndrome

Although isomerism of the bronchial tree is an integral part of hetrotaxy syndrome, the association of congenital tracheal stenosis is rare in this group of disorders, and it has not yet been thoroughly described in the literature. This condition is potentially life-threatening and precludes single ventricle palliation. This report presents the case of a 5-month old infant with symptomatic congenital tracheal stenosis, functionally univentricular heart and extracardiac total anomalous pulmonary venous connection (TAPVC). The condition was successfully treated with bidirectional Glenn anastomosis, central pulmonary artery plasty, repair of TAPVC and slide tracheoplasty.     

Surgical treatment of bronchial fistulas after pneumonectomy

The results of surgical treatment of 9 patients with bronchial fistulas after pneumonectomy have been analysed. During the reoperation the bronchial stump was wrapped by the omental flap with vascular pedicle (omentoplasty). In 6 patients omentoplasty was used in urgent repeated transpleural operations, in 3--during the late operations from transsternal transpericardial approach. Wedge resection of the tracheal bifurcation with omentoplasty from transsternal transpericardial approach was performed in 2 patients with a short bronchial stump. 2 patients died after surgery: one--from cardiopulmonary failure, the other one--from the relapse of bronchial fistula. Omentoplasty in patients with primary bronchial fistulas proved to be effective. It is advisable to perform reoperations during the 1st day after complications developed.     

非恶性食管-气管/支气管瘘的外科治疗

目的探讨非恶性食管-气管/支气管瘘的临床特点和处理方法。方法回顾性分析2002年1月至2011年10月北京协和医院收治12例非恶性食管-气管/支气管瘘患者的临床资料,其中男6例,女6例;平均年龄49.8(32～72)岁。食管气管瘘7例,食管支气管瘘1例,食管癌术后胸胃支气管瘘2例,食管憩室支气管瘘2例。右侧开胸入路9例,左侧开胸3例。行食管瘘、气管瘘修补7例;食管瘘、支气管瘘修补1例;胸胃瘘、支气管瘘修补术2例;食管下段、左肺下叶切除,食管胃弓下吻合术1例;左肺下叶切除,食管憩室瘘修补术1例。结果全部患者均顺利恢复,无手术合并症或死亡,7～10 d恢复经口进食。术后3个月～1年内复查纤维支气管镜及上消化道造影,无气管支气管狭窄,无食管狭窄,不必采用支架或扩张治疗。术后随诊3个月～10年,均恢复良好。结论食管-气管/支气管瘘排除恶性病因,明确瘘口位置,术前给予充分营养支持,手术Ⅰ期修补瘘口,可以获得良好的治疗效果。     

One Stage Surgical Correction of Congenital Cardiac Disease and Congenital Tracheal Stenosis in Infants and Children

Abstract   Objective: We describe our experience with patients undergoing one stage surgical correction of congenital cardiac disease and congenital tracheal stenosis. Methods: Between February 2001 and June 2007, eight patients underwent one stage repair of congenital cardiac disease and congenital tracheal stenosis. Their ages ranged from 30 days to 3 years (mean 16.25 ± 11.67 months) and weights from 4.2 to 10.5 kg (mean 8.24 ± 2.16 kg). The congenital cardiac disease was treated during cardiopulmonary bypass, and the tracheal stenosis was corrected simultaneously. Results: There was no operative mortality. One 4-month-old female who underwent polytetrafluroethylene patch tracheoplasty developed granulation tissue and died 3 months postoperatively of bronchial obstruction. The medium-term result of the remaining seven patients, after a mean follow-up of 50.4 months (range 9 to 76 months), was a stabile and complication-free clinical outcome. Conclusion: We advocate one stage surgical correction of congenital cardiac disease and congenital tracheal stenosis for the treatment of these conditions.     

24例隆凸气管主支气管肿瘤的外科治疗

总结１９８０－１９９４年２４例隆凸,气管,主支气管肿瘤病人手术治疗经验,方法,行气管、主支气管袖状切除对端合术１７例,隆凸切除重建术６例,气管纵行开窗刮除肿瘤减压术１例。结论：隆凸及气管手术比较复杂,手术难度大,但严和掌握的适应证,选择合理的术式及麻醉方法,可以取得满意的疗效。     

Gianturco self-expanding metallic stents in treatment of tracheobronchial stenosis after single lung and heart and lung transplantation

Three patients with recurrent bronchial stenosis following single lung transplant (SLTx), and one patient with tracheal stenosis following heart-lung transplantation (HLTx), not responding to repeated dilatations (3 patients) and prolonged use of silastic stents (patient with tracheal stenosis), have been treated by the endoscopic insertion of Gianturco self-expanding metallic stents under fluoroscopic control. The stent resulted in immediate improvement in respiratory function in all four patients. One patient (SLTx) had early bronchial re-stenosis due to growth of granulation tissue within the stent which was successfully treated by cryotherapy. In one patient (HLTx), a left lower lobe bronchial stenosis developed 14 months after tracheal stenting. The metallic stent appears to be a promising device in the management of recurrent or resistant bronchial stenosis following SLTx or tracheal stenosis after HLTx.     

The use of omental pedicle flap for tracheobronchial reconstruction in infants and children

For the surgical repair of long-segment tracheal stenosis, costal cartilage graft or extensive resection with end-to-end anastomosis has often been used. Both procedures have a risk of developing anastomotic leakage, which is potentially a lethal complication, or stenosis resulting from compromised blood supply to the tissue at the anastomosis. We have used omental pedicle flap (OPF) to seal the anastomotic line and to restore the vascularity of the graft and the trachea in an attempt to avoid fatal complications. During the period between 1986 and 1990, OPF technique was used in tracheobronchial reconstruction in six patients aged 4 months to 3 years; cartilage graft for extensive tracheal stenosis (4), tracheal resection and anastomosis (1), and bronchial resection and anastomosis (1). The omentum was separated from the colon to form an OPF with the right gastroepiploic vessels preserved. The OPF was brought to the upper trachea in the mediastinum through the retrosternal space. There was no immediate postoperative death due to anastomotic leak. Endotrachial tubes were removed in all patients. Four of the six are totally free of airway problems. One patient showed persistent stridor because of remaining stenosis at the cervical trachea. The remaining one patient who underwent bronchial resection developed anastomotic stenosis probably due to the compression of the floppy left main bronchus by adjacent aorta. The OPF seems to be an important surgical adjunct in order to eliminate fatal complications in tracheobronchial reconstruction.     

One-lung ventilation using a new original connector: with a bronchial blocker and a single lumen tracheal tube

We experienced 22 consecutive anaesthetic managements requiring one-lung ventilation for thoracotomy. We used our original connector, which enabled us to insert a bronchial blocker cut from Univent tube and fibreoptic bronchoscope into the single lumen tracheal tube without air leakage and instability. The bronchial blocker was easily introduced into the mainstem bronchus of the non-dependent lung. The pulmonary alveoli were well collapsed through air-vent inside the bronchial blocker, and we could offer good surgical field. When one-lung ventilation was finished during surgery, we removed the bronchial blocker with connector, and could insert a larger fibreoptic bronchoscope and a suction catheter into the single lumen tracheal tube. We could detach or exchange the bronchial blocker, when they are not functioning well. This method was excellent in the airway management for usual thoracotomy.