目的 探讨气管节段切除端对端吻合术治疗气管瘢痕性狭窄的有效性.方法 回顾性分析2009年1 1月至2015年3月用气管节段切除端对端吻合术治疗的40例气管狭窄患者临床资料.男28例,女12例;年龄6～64岁,平均33.7岁.狭窄程度按Myer-Cotton法分类:Ⅱ度7例,Ⅲ度22例,Ⅳ度11例.狭窄长度1.0～4.3 cm,平均2.5 cm.病因为气管插管辅助呼吸后引起者33例,颈部外伤后6例,气管内良性肿物切除后1例.结果 一次手术成功拔管34例(85.0％);6例失败,其中4例二次手术时改用气管加宽方法治愈.手术并发症为吻合口或气管造口肉芽生长8例,吻合口裂2例.没有发生喉返神经损伤或气管食管瘘者.结论 气管节段切除端对端吻合术是一种有效的治疗气管狭窄方法.一次手术成功率高,治疗周期短.%Objective To evaluate the efficacy of segmental tracheal resection with end-to-end anastomosis for cicatricial cervical tracheal stenosis.Methods The clinical outcomes of 40 patients treated with tracheal resection were retrospectively reviewed.There were 28 male patients and 12 female patients with the age ranged from 6 to 64 years (mean 33.7 years).The degree of stenosis was classified according to Myer-Cotton classification as follows:grade Ⅱ (n =7),grade Ⅲ (n =22) and grade Ⅳ (n =11).The stenosis extension ranged from 1.0 to 4.3 cm (mean 2.5 cm).The causes of the stenosis were postintubation (n =33),cervical trauma (n =6) and resection of tracheal neoplasm (n =1).Results Thirty-four(85.0％) patients were decannulated and 6 failed.Of the 6 patients failed,4 were decannulated after reoperation with the sternohyoid myocutaneous flap or thyroid alar cartilage graft.Complications occurred in 10 patients.In 8 patients granulation tissues formed at the site of the tracheal anastomosis,which needed endoscopic resction,and in 2 patients anastomosic dehiscence occurred.No injury to recurrent laryngeal nerve or trachoesophageal fistula occurred.Conclusion Segmental tracheal resection with end-to-end anastomosis is an effective surgical method for tracheal stenosis,which has a higher successful rate for primary operation and shorter therapeutic period.
展开▼
