CAJ | 학술논문

目的报道临床应用赵氏人工气管远期结果,介绍手术适应证及技术要点.方法回顾性分析3例气管腺样囊性癌、4例良性疾病(3例为外伤后气管缺损)气管大段切除后赵氏人工气管重建术者转归.良性者就医时均已做过气管切开,2例近端气管闭锁,不能说话.气管切除长度5.5-8.0Cm,人工气管长度3.0-4.5 cm.分两期手术,用整形外科技术制备成内面为皮肤,外面为颈阔肌,中间夹有记忆合金网,即带血供的肌肉血管蒂的"三明治式"人工气管,用以重建气管缺损.结果 2例术后带气管插管5 d,5例麻醉清醒后即拔除气管插管,正常呼吸、说话.术后第1 d即可下床活动,正常进食.3例恶性病人,1例住院期间死于气管一无名动脉瘘并发症,2例术后1年半分别死于急性肺动脉栓塞和肿瘤广泛转移.4例良性者均已术后3-5年,正常生活工作.结论赵氏人工气管设计合理,材料符合解剖和生理要求,只要手术操作细致,可以成功重建超过气管长度1/2的大段气管缺损.适用于气管恶性肿瘤和良性疾病的气管切除与重建.
목적 보도림상응용조씨인공기관원기결과,개소수술괄응증급기술요점.방법 회고성분석3례기관선양낭성암、4례량성질병(3례위외상후기관결손)기관대단절제후조씨인공기관중건술자전귀.량성자취의시균이주과기관절개,2례근단기관폐쇄,불능설화.기관절제장도5.5-8.0Cm,인공기관장도3.0-4.5 cm.분량기수술,용정형외과기술제비성내면위피부,외면위경활기,중간협유기억합금망,즉대혈공적기육혈관체적"삼명치식"인공기관,용이중건기관결손.결과 2례술후대기관삽관5 d,5례마취청성후즉발제기관삽관,정상호흡、설화.술후제1 d즉가하상활동,정상진식.3례악성병인,1례주원기간사우기관일무명동맥루병발증,2례술후1년반분별사우급성폐동맥전새화종류엄범전이.4례량성자균이술후3-5년,정상생활공작.결론 조씨인공기관설계합리,재료부합해부화생리요구,지요수술조작세치,가이성공중건초과기관장도1/2적대단기관결손.괄용우기관악성종류화량성질병적기관절제여중건.
Objective To report the long-term results of clinical application of ZHAO's artificial trachea.Introduce the indication and technical key point. Methods Seven patients undergoing long-segment resection of trachea received tracheal reconstruction with ZHAO's artificial traches. There were 3 ocstoid adenocarcinomas and 4 benign cases including 3 trauma patients. Four benign patients had tracheostomy before admission; two of them with closed upper trachea lost the ability of speech. The length of tracheal de-fect were 5.5-8.0 cm, the length of artificial trachea were 3.0-4.5 cm. Reconstruction procedure was two-staged. With plastic surgery technique, a "sandwich" pedicle artificial trachea was made, of which the inner surface was skin, outer coveting was platysma, a memory-alloy mesh was in between. Results Two patients required intubation for 5 days. Five patients could speak normally,wald around and have normal food in first postoperative day. Three malignant patients died. One died from trachon-innominate arterial fistular, 2 died from acute pulmonary embolism end systemic malignancy 1.5 year later. Four benign patients survived 3 - 5 years with normal life and word. Conclusion The design of ZHAO's artificial trachea is practicable. The artificial material comparatively copes with tracheal anatomy and physiology. It is an alternative choice for tracheal reconstruction after more than half length long-segment resection. It is suitable for both malignancy and binign condition.