Tracheal stenosis treated with vascularized mucosa and short-term stenting
Tracheal stenosis treated with vascularized mucosa and short-term stenting
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DOI：
10.1097/01.mlg.0000162658.78164.82
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发表时间：
2005-06-01
期刊：
影响因子：
2.6
通讯作者：
Hermans, R
中科院分区：
文献类型：
--
作者：
Delaere, P;Hierner, R;Hermans, R
对于狭窄小于气管长度50%的患者，气管节段性切除端到端吻合是首选的治疗方法。气管切除术的优点是不需要移植物，也不需要长时间的气管插管。1,2当不能切除气管时，如长节段狭窄或气管切除后再狭窄时，需要通过插入局部、局部或远处组织来增加气管腔。气管重建使用修复组织是第二选择的解决方案，因为最佳的修复组织是不可用的。最常用的重建组织包括软骨移植物、心包、3和肌瓣（用作皮肤、骨膜或骨的载体）。这些重建组织获得的结果不是恒定的，因为它们都缺乏最佳气管修复的一个或多个要求。实验评估表明，最佳的喉气管修复应尽可能接近天然气管组织，由软骨支撑、由呼吸粘膜组成的内层和可靠的血液供应组成。5,6这些组织特征可以在血管重建的气管异体和自体移植物中发现（图1）。然而，在处理气管再狭窄或长段狭窄时，气管同种异体和自体移植是不可用的。在以往的动物实验中，我们尽可能寻找与最佳组织匹配的自体组织。血管化筋膜（供血）、颊黏膜（内层）和弹性软骨（支撑）组成的复合组织与血管化气管移植非常匹配。然而，皮瓣预制是允许软骨成分愈合的必要条件，因为裸露的软骨在直接暴露于气道管腔时发生坏死。由带血管的筋膜和粘膜组成的复合组织可在一期手术中使用。血管化粘膜可修复气道缺损，重建部位可初步愈合。由于没有软骨支撑部件，气道管腔的扩张将不太明显（图1）。虽然支持是不可用的，血管筋膜内衬颊粘膜可以成功地解决难以治疗的气道狭窄。在这里，它与短期气道支架术联合使用，并在一个节段性切除后再狭窄的病例中进行了说明。
Segmental tracheal resection with end-to-end anastomosis is the treatment of choice for a stenosis encompassing less than 50% of the tracheal length. The advantage of a tracheal resection is that no graft is necessary and that there is no need for prolonged endotracheal intubation. 1, 2 Augmentation of the tracheal lumen by inserting local, regional, or distant tissue is necessary when a tracheal resection is not possible as, for example, in long-segment stenosis or in cases of restenosis after tracheal resection. Tracheal reconstruction by using repair tissue is a second choice solution because the optimal repair tissue is not available. The most frequently used reconstructive tissues consist of cartilage grafts, pericardium, 3 and muscle flaps (used as a carrier for skin, 4 periosteum, or bone). Results obtained with these reconstructive tissues are not constant because they all lack one or more requirements for optimal tracheal repair. Experimental evaluation showed that optimal laryngotracheal repair should resemble the native tracheal tissue as closely as possible and be composed of a cartilaginous support, an internal lining consisting of respiratory mucosa, and a reliable blood supply. 5, 6 These tissue characteristics may be found in revascularized tracheal allo-and autografts (Fig. 1). Tracheal allo-and autotransplants are, however, not available when dealing with tracheal restenosis or long-segment stenosis.In previous animal experiments, we looked for autologous tissue matching the optimal tissue as closely as possible. Composite tissue consisting of vascularized fascia (blood supply), buccal mucosa (internal lining), and elastic cartilage (support) was found to closely match vascularized tracheal transplants. 5 Flap prefabrication was, however, a requirement to allow for healing of the cartilage component because bare cartilage underwent necrosis when directly exposed to the airway lumen. 6 Composite tissue consisting of vascularized fascia and mucosa could be used in a one-stage procedure. Vascularized mucosa can repair airway defects with primary healing of the reconstructed site. Expansion of the airway lumen will be less pronounced because the cartilaginous supportive component is not available (Fig. 1). Although support is not available, vascularized fascia lined with buccal mucosa can succeed in solving difficult to treat airway stenosis. It is used here in combination with short-term airway stenting and is illustrated in a case of restenosis after segmental resection.