Successful Tracheal Replacement in Humans Using Autologous Tissues: An 8-Year Experience
Successful Tracheal Replacement in Humans Using Autologous Tissues: An 8-Year Experience
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DOI：
10.1016/j.athoracsur.2013.05.073
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发表时间：
2013-10-01
影响因子：
4.6
通讯作者：
Dartevelle, Philippe
中科院分区：
文献类型：
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作者：
Fabre, Dominique;Kolb, Frederic;Dartevelle, Philippe
背景。用合成材料和异体组织进行了50年的外科研究，却未能找到一种好的、耐用的气管替代品。我们研究了不需要人工合成材料或免疫抑制的自体气管替代（ATS）。对于ATS，我们采用单阶段手术，从前臂游离筋膜皮瓣构建一根管，该皮瓣由桡动脉血管构成，与乳腺内血管再吻合，并通过横向插入皮下组织的肋骨软骨加强。气管切除7 ~ 12 cm（平均11 cm）治疗8例原发性气管肿瘤，包括5例腺样囊性癌（ACC）和3例鳞状细胞癌（SCC）；继发性气管肿瘤3例，其中甲状腺癌1例，淋巴瘤2例；1例插管后长期支架术后气管破坏。暂时性气管切开术与纤毛粘液清除缺失相关。自2004年以来，已有12例患者接受了ATS手术，另有4例患者接受了额外的切除术，包括1例单独隆突切除术，1例联合肺叶切除术和2例咽喉部切除术。所有患者均于术后第1天拔管。8例患者术后平均存活36个月（范围2 ~ 94个月），无呼吸窘迫。2例ATS合并隆突切除患者死于肺部感染。内窥镜、动态计算机断层扫描或肺活量测定术均未发现气道塌陷。两名患者仍然有气管切开术，因为手术在近端吻合处的水平过低。一名慢性严重呼吸功能不全的患者最近需要远端短支架。ATS是一种良好、耐用的气管替代物，由于其横向刚性，可抵抗呼吸压力变化，且无任何免疫抑制作用。(C) 2013年由胸外科学会发布
Background. Fifty years of surgical research using synthetic materials and heterologous tissues failed to find a good, durable replacement for the trachea. We investigated autologous tracheal substitution (ATS) without synthetic material or immunosuppression.Methods. For ATS, we used a single-stage operation to construct a tube from a forearm free fasciocutaneous flap vascularized by radial vessels that was reanastomosed to internal mammary vessels and reinforced by rib cartilages interposed transversally in the subcutaneous tissue. Tracheal resections 7 to 12 cm long (mean, 11 cm) were done to treat 8 primary tracheal neoplasms, including 5 adenoid cystic carcinomas (ACC) and 3 squamous cell carcinomas (SCC); 3 secondary tracheal neoplasms, including 1 thyroid carcinomas and 2 lymphomas; and 1 postintubation tracheal destruction after a long history of stenting. Transitory tracheotomy was associated to the absence of mucociliary clearance.Results. ATS has been performed in 12 patients since 2004, with additional resections in 4 patients, comprising 1 carinal resection alone, 1 associated with lobectomy, and 2 pharyngolaryngectomies. All patients were extubated on postoperative day 1. Eight patients are alive at a mean of 36 months (range, 2 to 94 months) postoperatively, with no respiratory distress. The 2 patients with ATS and carinal resections died of pulmonary infection. No airway collapse has been detected by endoscopy, dynamic computed tomography scan, or spirometry. Two patients still have a tracheotomy because the procedure was performed too low at the level of the proximal anastomosis. One patient with a chronic severe respiratory insufficiency recently required a distal, short stent.Conclusions. ATS is a good, durable, tracheal substitution that resists respiratory pressure variations because of transverse rigidity, without any immunosuppression. (C) 2013 by The Society of Thoracic Surgeons