山东大学耳鼻喉眼学报 ›› 2020, Vol. 34 ›› Issue (3): 52-57.doi: 10.6040/j.issn.1673-3770.1.2020.032

• 临床研究 • 上一篇    下一篇

皮瓣二期重建策略应用于气管非环周缺损修复重建

邓迪,刘均,李林珂,王吉,刘吉峰,吕丹,王海洋,甘卫刚,王君,李波,陈飞   

  1. 四川大学华西医院 耳鼻咽喉头颈外科, 四川 成都 610041
  • 发布日期:2020-06-29
  • 通讯作者: 陈飞. E-mail:hxchenfei@163.com
  • 基金资助:
    四川省科技厅重点研发(社会发展)项目(2018SZ0133)

Two-stage reconstructive strategy using a flap for non-circumferential tracheal defects

DENG Di, LIU Jun, LI Linke, WANG Ji, LIU Jifeng, LV Dan, WANG Haiyang, GAN Weigang, WANG Jun, LI Bo, CHEN Fei   

  1. Department of Otorhinolaryngology & Head and Neck Surgery, West China Hospital, Sichuan University, Sichuan 610041, Chengdu, China
  • Published:2020-06-29

摘要: 目的 探讨皮瓣二期重建策略在气管非环周缺损修复重建的临床应用价值。 方法 回顾性分析2013年3月~2018年12月期间采用皮瓣二期重建气管非环周缺损的患者临床资料。 结果 37例完成I期重建,气管壁缺损长度为6~14个气管环,环周比为1/2~3/4,其中采用游离皮瓣22例,带蒂皮瓣15例,大小为6 cm×4 cm~12 cm×9 cm。33例患者顺利完成II期手术,术后呼吸、吞咽及发音功能恢复较为满意。 结论 对气管非环周缺损采取皮瓣二期重建策略有利于患者呼吸管理,治疗方案安全、有效。

关键词: 气管缺损, 二期重建, 甲状腺癌, 外科皮瓣

Abstract: Objective This study aimed to investigate the clinical value of two-stage reconstructive strategy using a flap for the treatment of non-circumferential tracheal defects. Methods Patients who underwent tracheal reconstructions with a two-stage reconstructive strategy using a flap between March 2013 and December 2018 were retrospectively evaluated. Results Thirty-seven patients, with a tracheal defect length of 6-14 tracheal rings and circumferential ratio of 1/2 to 3/4, underwent stage I surgery. Twenty-two free flaps and 15 pedicled flaps were used in the stage I surgery, and the sizes of the flap ranged from 6×4 cm to 12×9 cm. Thirty-three patients underwent stage II surgery, and the postoperative respiratory, deglutition, and articulation functions recovered satisfactorily. Conclusion The two-stage reconstructive strategy using a flap is safe and effective for the treatment of non-circumferential tracheal defects.

Key words: Tracheal defect, Two-stage reconstruction, Thyroid carcinoma, Surgical flap

中图分类号: 

  • R739.63
[1] 杨新明. 颈段气管肿瘤的外科处理[J]. 中国耳鼻咽喉颅底外科杂志, 2016, 22(4): 257-260. doi:10.11798/j.issn.1007-1520.201604001. YANG Xinming. Surgical treatment of cervical tracheal tumors[J]. Chinese Journal of Otorhinolaryngology-skull Base Surgery, 2016, 22(4): 257-260. doi:10.11798/j.issn.1007-1520.201604001.
[2] Ninkovic M, Buerger H, Ehrl D, Dornseifer U. One-stage reconstruction of tracheal defects with the medial femoral condyle corticoperiosteal-cutaneous free flap. Head Neck. 2016, 38(12): 1870-1873.
[3] Zhou ZJ, Zhou AY, Zhao YY, et al. Evaluating the Clinical COPD Questionnaire: a systematic review[J]. Respirology, 2017, 22(2): 251-262. doi:10.1111/resp.12970.[PubMed]
[4] 王嘉森, 李力, 肖燎原, 等. 颈前旋转肌皮瓣修复喉部分切除术后缺损的喉功能评价[J]. 第二军医大学学报, 2013, 34(7): 745-749. WANG Jiasen, LI Li, XIAO Liaoyuan, et al. Functional recovery of laryngeal reconstruction with the anterior cervical turnover myocutaneous flap after partial laryngectomy[J]. Academic Journal of Second Military Medical University, 2013, 34(7): 745-749.
[5] 吴跃煌, 刘绍严. 局部张力随意皮瓣修复气管大型缺损的临床实践[J]. 中华耳鼻咽喉头颈外科杂志,2018,53(6): 424-427. doi:10.3760/cma.j.issn.1673-0860.2018.06.006. WU Yuehuang, Liu Shaoyan. Clinical practice of repair of large tracheal defects with local tension free flaps[J]. Chinese Journal of Otorhinolaryngology Head and Neck Surgery, 2018,53(6): 424-427. doi:10.3760/cma.j.issn.1673-0860.2018.06.006.
[6] Nandakumar R, Jagdish C, Prathibha CB, et al. Tracheal resection with end-to-end anastomosis for post-intubation cervical tracheal Stenosis: study of 14 cases[J]. J Laryngol Otol, 2011, 125(9): 958-961. doi:10.1017/S002221511100137X.
[7] Zanetta A, Cuestas G, Rodríguez H, et al. Laryngotracheal reconstruction with cryopreserved aortic allograft as a salvage technique when cricotracheal resection complications occur in paediatrics[J]. Acta Otorrinolaringol Esp, 2014, 65(3): 191-193. doi:10.1016/j.otorri.2012.07.006.
[8] Steinke M, Dally I, Friedel G, et al. Host-integration of a tissue-engineered airway patch: two-year follow-up in a single patient[J]. Tissue Eng Part A, 2015, 21(3/4): 573-579. doi:10.1089/ten.TEA.2014.0200.
[9] Xie H, Zhang YQ, Yu FL, et al. Repair of a defect in the cervical Trachea with thyroid-pericardium flap: a case report[J]. Medicine(Baltimore), 2019, 98(46): e17871. doi:10.1097/MD.0000000000017871.
[10] Gonfiotti A, Jaus MO, Barale D, et al. The first tissue-engineered airway transplantation: 5-year follow-up results[J]. Lancet, 2014, 383(9913): 238-244. doi:10.1016/S0140-6736(13)62033-4.
[11] Abouarab AA, Elsayed HH, Elkhayat H, et al. Current solutions for long-segment tracheal reconstruction[J]. Ann Thorac Cardiovasc Surg, 2017, 23(2): 66-75. doi:10.5761/atcs.ra.16-00251.
[12] Thomet C, Modarressi A, Rüegg EM, et al. Long-segment tracheal reconstruction with free radial forearm flap reinforced by rib cartilage[J]. Ann Plast Surg, 2018, 80(5): 525-528. doi:10.1097/SAP.0000000000001399.
[13] 雷大鹏, 潘新良, 许风雷, 等. 胸锁乳突肌肌骨膜瓣在颈段气管修复中的应用[J]. 临床耳鼻咽喉科杂志, 2001, 15(4): 169-170. LEI Dapeng, PAN Xinliang, XU Fenglei, et al. Clinical studies on sternocleidomastoid myoperiosteal flap for cervical tracheal reconstruction[J]. Journal of Clinical Otorhinolaryngology, 2001, 15(4): 169-170.[知网]
[14] 简超, 陶圣祥, 谭金海, 等. 带蒂胸大肌肌腱瓣移位修复颈部气管壁缺损的解剖及初步临床应用[J]. 中华显微外科杂志,2015,38(4): 350-353. doi:10.3760/cma.j.issn.1001-2036.2015.04.011. JIAN Chao, TAO Shengxiang,TAN Jinhai,et al. Anatomical and preclinical study of repair of cervical tracheal wall defects with vascularized pectoralis major tendon flaps[J]. Chinese Journal of Microsurgery, 2015,38(4): 350-353. doi:10.3760/cma.j.issn.1001-2036.2015.04.011.
[15] Kubo T, Kurita T, Tashima H, et al. Immediate tracheal reconstruction with forearm flap and bone graft[J]. Microsurgery, 2019, 39(1): 46-52. doi:10.1002/micr.30365.
[16] 陈爱民, 骆献阳. 分化型甲状腺癌侵犯喉气管食管临床分析[J]. 临床耳鼻咽喉头颈外科杂志, 2017, 31(10): 802-803. doi:10.13201/j.issn.1001-1781.2017.10.016. CHEN Aimin, LUO Xianyang. Clinical analysis of differentiated thyroid carcinoma invading larynx and tracheal esophagus[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery, 2017, 31(10): 802-803. doi:10.13201/j.issn.1001-1781.2017.10.016.
[17] 张俊, 边丽, 王思惠, 等. 头颈部肿瘤修复皮瓣对放疗的耐受性[J]. 现代肿瘤医学, 2019, 27(10): 1717-1720. ZHANG Jun, BIAN Li, WANG Sihui, et al. Tolerance of the repair flap of head and neck tumor to radiotherapy[J]. Journal of Modern Oncology, 2019, 27(10): 1717-1720.
[18] Chuang FC, Tung KY, Huang WC, et al. Using a sternocleidomastoid muscle flap to close an iatrogenic tracheoesophageal fistula in a patient with advanced laryngeal cancer: a case report and literature review[J]. Ann Plast Surg, 2019, 82(1S Suppl 1): S126-S129. doi:10.1097/SAP.0000000000001718.
[19] Zender CA, Patel AV, Strohl M, et al. The prefabricated supraclavicular artery flap in high-risk tracheal Stenosis patients[J]. Laryngoscope, 2020, 130(3): 641-648. doi:10.1002/lary.28068.
[20] Ghali S, Chang EI, Rice DC, et al. Microsurgical reconstruction of combined tracheal and total esophageal defects[J]. J Thorac Cardiovasc Surg, 2015, 150(5): 1261-1266. doi:10.1016/j.jtcvs.2011.10.100.[PubMed]
[21] 林云, 潘新良, 刘大昱, 等. 局部组织瓣在喉切除术后一期重建中的应用[J]. 山东大学耳鼻喉眼学报, 2018,32(1): 56-60. doi:10.6040/j.issn.1673-3770.0.2017.526 LIN Yun, PAN Xinliang, LIU Dayu,et al. The application of local tissue flaps in primary reconstruction of laryngeal function after laryngectomy[J]. Journal of Otolaryngology and Ophthalmology of Shandong University, 2018,32(1): 56-60. doi:10.6040/j.issn.1673-3770.0.2017.526
[22] Liu J, Lu D, Deng D, et al. Free posterior tibial artery perforator flap for 2-stage tracheal reconstruction in patients after resection of well-differentiated thyroid carcinoma invading the Trachea[J]. Head Neck, 2019, 41(7): 2249-2255. doi:10.1002/hed.25675.
[1] 张轶轶,薛刚,金春亭. 外泌体在甲状腺癌的研究进展[J]. 山东大学耳鼻喉眼学报, 2021, 35(2): 131-135.
[2] 潘新良. 加强甲状腺结节及恶性肿瘤的规范治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 1-12.
[3] 陈海兵, 卫亚楠, 许晓泉, 陈曦. 基于XGBoost人工智能结合CT构建甲状腺癌颈部淋巴结转移预测模型[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 40-45.
[4] 房忠菊, 张永侠, 赵建东, 纵亮, 翟性友, 李新建, 彭新, 任楠, 陈立伟, 刘明波. 甲状腺癌颈清扫术后乳糜漏的综合治疗[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 64-68.
[5] 吕静荣,陈淳,马衍,谢晋. 儿童分化型甲状腺癌的临床特征及危险因素分析[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 88-94.
[6] 冯云,钟志明,陈国庆. 纳米碳在甲状腺乳头状癌隐匿性侧颈转移淋巴结清扫术中的临床应用价值[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 101-106.
[7] 马驰,郑桂彬,孙海清,吴国长,郭雅文,孔杨,宋西成,郑海涛. 加速康复外科理念应用于甲状腺癌手术100例[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 107-110.
[8] 王佳说, 郭星, 阎艾慧. 甲状腺乳头状癌颈淋巴结转移形成巨大囊性变的诊断总结[J]. 山东大学耳鼻喉眼学报, 2020, 34(3): 111-113.
[9] 高晓倩,姜震,耿琛琛,刘大昱,李荔. 术前超声评估分化型甲状腺癌颈部淋巴结转移[J]. 山东大学耳鼻喉眼学报, 2019, 33(1): 135-139.
[10] 吴晴伟,赵影颖,王珮华,王钟颖,陈东. 鼻尖鼻背缺损延期局部皮瓣修复的疗效观察[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 14-17.
[11] 李学新,姜震,岳建林,林云,孙睿杰,刘大昱,潘新良. 带蒂肌皮瓣及脏器瓣在咽、食管缺损修复中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 48-52.
[12] 林云,潘新良,刘大昱,孙睿杰,李学新,姜震,岳建林. 局部组织瓣在喉切除术后一期重建中的应用[J]. 山东大学耳鼻喉眼学报, 2018, 32(1): 56-60.
[13] 邱杰,孙莎莎,孙彦. 美国癌症联合委员会第8版甲状腺癌TNM分期解读[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 5-8.
[14] 徐书杭, 李春睿, 刘超. 儿童甲状腺癌的规范化诊治[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 12-15.
[15] 普布次仁,刘吉峰,巴罗. 甲状腺癌与外周静脉血炎性相关指标[J]. 山东大学耳鼻喉眼学报, 2017, 31(6): 21-24.
Viewed
Full text


Abstract

Cited

  Shared   
  Discussed   
[1] 张晗,黄一飞 . 抗角膜移植排斥的研究进展[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 84 -87 .
[2] 牛善利,柴茂文,李振秀 . 鼻内镜下鼻甲成形术治疗慢性肥厚性鼻炎60例[J]. 山东大学耳鼻喉眼学报, 2006, 20(1): 16 -18 .
[3] 孟庆国,卢永田,范献良 . 杀伤细胞免疫球蛋白样受体基因多态性与鼻咽癌的关联性[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 196 -199 .
[4] 马玉起,孔祥春 . 先天性双侧下唇窦道1例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 199 -199 .
[5] 万俐佳,鲁海涛,姜义道,刘 辉,李 琴,佘腊枝 . 改良腭咽成形术治疗阻塞性睡眠呼吸暂停综合征41例[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 204 -205 .
[6] 于青青 ,王跃建 . 硬质耳内镜的临床应用进展[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 222 -224 .
[7] 吉晓滨,邓家德,臧林泉,王 磊,谢 军 . 豚鼠变应性鼻炎模型血清组胺的测定[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 228 -230 .
[8] 向登,卢永田,孙焕吉 . 鼻内镜下修补脑脊液鼻漏19例并文献复习[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 234 -236 .
[9] 邱恩惠,李志春,方文旭 . 嗅觉障碍的中西医治疗[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 253 -257 .
[10] 殷国华,钟 笑 . 激光减容术治疗舌扁桃体肥大的远期疗效[J]. 山东大学耳鼻喉眼学报, 2008, 22(3): 280 -282 .