气管袖状切除及端端吻合术治疗颈段重度气管狭窄临床分析  

Tracheal sleeve resection and end-to-end anastomosis in management of severe tracheal stenosis

作　　者：宋业勋[1] 谢骏[2] 谭国林[1] 李和清[1] SONG Yexun;XIE Jun;TAN Guolin;LI Heqing(Department of Otolaryngology Head and Neck Surgery,the Third Xiangya Hospital of Central South University,Changsha,Hunan,410013,China;Department of Otolaryngology Head and Neck Surgery,Hunan Children＇s Hospital,Changsha,Hunan,410013,China)

机构地区：[1]中南大学湘雅三医院耳鼻咽喉头颈外科,湖南长沙410013 [2]湖南省儿童医院耳鼻咽喉头颈外科,湖南长沙410013

出　　处：《中国耳鼻咽喉头颈外科》2018年第7期389-392,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

摘　　要：目的分析III^IV级颈段重度气管狭窄的临床、影像特征,探讨气管狭窄段袖状切除及端端吻合术的疗效及并发症的预防。方法回顾性分析2008年7月~2016年7月收治的20例不同病因所致的III^IV级颈段重度气管狭窄患者的临床资料,全部病例均采用气管狭窄段袖状切除及端端吻合术治疗。结果 20例患者均实施气管狭窄段袖状切除及端端吻合术,其中17例(85.0%)术后顺利拔管,3例(15.0%)术后发生吻合口再狭窄。术后并发症包括手术切口皮下感染1例,颈部皮下气肿4例,暂时性单侧声带麻痹3例,无吻合口瘘、喉返神经不可逆损伤等严重并发症发生。无术中、术后死亡病例发生。结论气管袖状切除及端端吻合是针对颈段重度气管狭窄的一种有效的治疗手段。长段气管狭窄不应作为该术式的一个绝对治疗禁忌证。合并糖尿病的气管狭窄患者应该慎重选择该术式作为首选治疗方案。OBJECTIVE To review the clinical and image features of the patients with grade III-IV tracheal stenosis, and the surgical outcomes of tracheal sleeve resection and end-to-end anastomosis in the treatment of severe tracheal stenosis. METHODS Between July2008 and July 2016, 20 patients with grade III-IV tracheal stenosis underwent tracheal sleeve resection and end-to-end anastomosis. RESULTS Postoperative decannulation was achieved in 17 patients（85.0%）, and restenosis developed in3 patients（15.0%）. Postoperative complications were： 1 case wound infection, 4 cases subcutaneous emphysema, 3 cases temporary unilateral vocal fold palsy. Suture dehiscence,irreversible injury of the recurrent laryngeal nerves was not observed in our patients. No perioperative mortality occurred. CONCLUSION The tracheal sleeve resection and end-to-end anastomosis represent a viable treatment for severe tracheal stenosis. Long segment stenosis should not be considered as a contraindication. This surgical method should be considered cautiously in patients with diabetes.

关 键 词：气管切除术 气管狭窄 外科手术 端端吻合 拔管 

分 类 号：R655[医药卫生—外科学]