Ⅰ期端端吻合术治疗重度颈段气管狭窄临床分析

目的 探讨Ⅰ期气管、环气管部分切除端端吻合术在治疗重度颈段气管狭窄中的有效性、适应证和风险因素。 方法 回顾性分析2015年3月至2019年11月采用Ⅰ期部分气管、环气管切除端端吻合术治疗的重度颈段气管狭窄患者29例。其中男19例,女10例,17~51岁,平均31岁。手术方法包括气管-气管端端吻合(18例)、环气管吻合(9例)和甲状软骨气管吻合(2例)。狭窄程度按照Myer-Cotton法分为Ⅲ度18例,Ⅳ度11例。 结果 狭窄长度1~4 cm,平均2.5 cm。一次性手术成功拔管25例(86%)。术后并发症:皮下气肿1例,再次狭窄4例,吻合口裂1例,暂时性声带麻痹1例。 结论 Ⅰ期端端吻合术是一种有效治疗重度颈段气管狭窄的手术方法,手术成功率高。严格的术前适应证选择和术者经验是手术成功的关键。

Single-stage end-to-end anastomosis in the management of severe cervical tracheal stenosis

Objective To evaluate the efficacy, indications and risk factors of single-stage end-to-end anastomosis in the treatment of severe cervical tracheal stenosis. Methods A retrospective analysis was performed on 29 patients with severe cervical tracheal stenosis treated with single-stage partial tracheal or cricotracheal resection with primary end-to-end anastomosis during Mar. 2015 and Nov. 2019, including 19 male and 10 female, age ranged from 17 to 51(mean 31)years. Tracheotracheal end-to-end anastomosis was performed in 18 cases, cricotracheal end-to-end anastomosis in 9 cases and thyrotracheal anastomosis in 2 cases. The degree of stenosis was classified according to Myer-Cotton classification as grade Ⅲ in 18 cases and grade Ⅳ in 11 cases. Results Length of stenosis was 1-4 cm(mean 2.5 cm). Successful decannulation was achieved in 25 cases(86%). Postoperative complications included subcutaneous emphysema in 1 case, restenosis in 4 cases, anastomosic dehiscence in 1 case, and temporary unilateralvocal fold palsy in 1 case. Conclusion Single-stage end-to-end anastomosis is safe and effective in the management of advanced cervical tracheal stenosis. Careful preoperative evaluation of indications and operators experiences play the most important roles in achieving a positive outcome.