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find Keyword "气管狭窄" 15 results
  • 气管外科手术16例临床分析

    目的 总结气管疾病患者行外科手术治疗的临床经验。 方法 回顾性分析2007年7月至2011年2月上海交通大学附属第六人民医院16例气管创伤或气管疾病患者施行气管手术的临床资料,男9例,女7例;年龄7~65岁。气管创伤6例,气管切开后气管狭窄5例,原发性气管肿瘤4例,甲状腺癌侵犯气管1例。因16例患者的病因不同,分别行气管外伤直接缝合或病变段气管环形切除+对端吻合术。 结果 所有患者均治愈或好转出院,术后无并发症发生。随访15例,随访时间3~12个月,患者呼吸情况良好。随访期间9例行病变段气管环形切除、对端吻合的患者无吻合口狭窄、吻合口裂开。1例甲状腺癌侵犯气管的患者手术后继续行放化疗治疗,3个月后失访。 结论 气管外科手术依其病因不同分别有其各自的手术处理要点。

    Release date:2016-08-30 05:50 Export PDF Favorites Scan
  • 先天性心脏病合并气道异常的围术期处理

    摘要: 目的 提高对先天性心脏病合并气道异常的认识,总结围术期处理经验。 方法 对中南大学湘雅二医院2006年1月至2008年1月收治的5例先天性心脏病合并气道异常患者的临床资料进行回顾性分析,其中男3例,女2例;年龄5个月~9岁,平均年龄27个月。气道异常包括:左主支气管狭窄2例,右侧气管化支气管、气管轻度软化和左主支气管狭窄、长段先天性气管狭窄各1例。行先天性心脏病矫治术加左主支气管成形术1例,仅行先天性心脏病矫治术3例,放弃手术治疗1例。 结果 围术期死亡1例,为先天性心脏病合并右侧气管化支气管,术后发生右肺上叶不张、肺部感染和呼吸衰竭死亡。1例先天性心脏病合并左主支气管狭窄,同期行左主支气管成形术后顺利出院;随访2年健康。1例行先天性心脏病矫治术后撤离呼吸机困难,发现合并先天性左主支气管狭窄伴轻度气管软化,经内科处理撤离呼吸机后仍有喘憋;随访6个月患者发育好,喘憋未再发作。1例混合型室间隔缺损致心脏扩大、肺动脉扩张压迫左主支气管导致狭窄,行先天性心脏病矫治术后左主支气管压迫症状缓解;随访1年健康。1例合并长段气管狭窄,家属放弃手术。 结论 先天性心脏病合并气道异常临床上很少见。应提高对该病的认识,做到术前确诊;采用最佳的手术方法,尽量与先天性心脏病同期手术纠治;术后加强呼吸道管理,以获得最佳的疗效。

    Release date:2016-08-30 06:03 Export PDF Favorites Scan
  • APPLICATION OF VARIOUS MATERIALS IN RECONSTRUCTION OF LARYNGOTRACHEAL FRAMEWORK/

    Objective To investigate the effectiveness of various materials in reconstruction of laryngotracheal framework and to analyze the advantages, disadvantage, and indication of each material. Methods The cl inical data were retrospectively analyzed, from 337 laryngotracheal stenosis patients undergoing laryngotracheal framework reconstruction with various materials between October 1986 and October 2006. There were 229 males and 108 females aged from 2 to 54 years (median, 23.5 years). According to Cotton’s grading criteria for laryngotracheal stenosis, there were 94 cases of grade II, 218 cases of grade III, and 25 cases of grade IV, and all accompanied by laryngotracheal framework defect of 1-5 cm. The costal cartilage autograft was performed in 157 cases, thyroid cartilage graft in 27 cases, nasal septal cartilage graft in 8 cases, sternohyoid myocutaneous rotary door flap graft in 104 cases, hyoid bone flap of sternocleidomastoideus graft in 7 cases, musculo-periosteum flap of sternocleidomastoideus with clavicular periosteum in 21 cases, hydroxyapatite artificial tracheal ring graft in 10 cases, and pedicle myocutaneous flap with “C” shape nickel-titanic alloy net graft in 3 cases. Silastic T-tube was used after reconstruction for 6-12 months. Results Infection occurred in 5 cases and the incisions healed by second intention, the others achieved healing of incision by first intention. Intratracheal granulation formation occurred in 23 cases and choke when taking food in 6 cases; they were all cured after symptomatic treatment. After operation, 4 cases failed to be followed up and 12 cases did not recover, including 6 cases of costal cartilage autograft, 1 case of hyoid bone flap of sternocleidomastoideus graft, and 5 cases of sternohyoid myocutaneous rotary door flap graft. A total of 321 patients were followed up for 1-10 years (mean, 3.5 years). The patients had no laryngotracheal restenosis with good swallowing function and respiratory function. Conclusion Different materials of laryngotracheal framework reconstruction have advantages and disadvantage respectively. The appropriate material should be selected according to the special details of pathological change, and the satisfactory curative effect may be obtained.

    Release date:2016-08-31 05:44 Export PDF Favorites Scan
  • APPLICATION OF EPIGLOTTIC IN RECONSTRUCTION OF TRAUMATIC LARYNGOTRACHEAL STENOSIS

    Objective To investigate the application and long-termresults of epiglottic in reconstruction of the traumatic laryngotracheal stenosis.Methods From January 1988 to February 2002, 42 patients with traumatic laryngotracheal stenosis were treated, including 33 laryngeal stenosis and9 laryngotracheal stenosis. The following surgical treatment were performed: ① lowered epiglottic andbi-pedicled sternohyoid myofascial flap and ② lowered epiglottic and bipedicledsternohyoid myofascial flap and sternocleidomastoideus clavicle membrane flap. Results Thirty-seven patients(88.1%) were successfully decannulated 10 to 75 daysafter operation. Feeding tube lasted from 9 to 24 days, all the patients rehabilitated deglutition after surgery. The time of using stent was 9 to 19 days in 25cases.All patients were followed up 1 year to 3 years and 4 months. The function of larynx recovered completely in 37 decannulated patients and partially in 5cannulated patients. Conclusion Epiglottic- has the advantages of easy gain, high antiinfection and survival rate, and stable structure. A combination of epiglottic and the bipedicled sternohyoid myofascial flap plus sternocleidomastoideus clavicle membrane flap can repair large laryngeal and tracheal defects.

    Release date:2016-09-01 09:29 Export PDF Favorites Scan
  • Airway Reconstruction supported by Extracorporeal Membrane Oxygenation

    Objective To explore the feasibility and safety of extracorporeal membrane oxygenation (ECMO) to support the airway reconstruction for the patients with airway obstruction or stenosis who cannot be ventilated routinely. Methods There were 3 patients received trachea reconstruction procedures assisted by ECMO. Among the patients, 2 cases with tracheal neoplasms underwent fibrobrochoscopy treatments, another one with endotracheal stenosis and fistula received tracheoplasty and semi-tracheostomy. Results ECMO can provide enough oxygenation for the patients with airway obstruction or stenosis and more time for advanced therapies. All three patients recovered after interventional surgeries, in whom one case died due to multiple organ failure caused by esophageal carcinoma metastasis after 3 months, and the others survived with dyspnea classification of 2-3 grade. Conclusion ECMO can be a safe and effective approch for the patients who cannot be ventilated conventionally in airway reconstruction.

    Release date:2016-10-02 04:56 Export PDF Favorites Scan
  • 气管良性狭窄袖式切除重建外科治疗

    目的探讨气管良性狭窄的临床特点和外科手术治疗策略。 方法回顾性分析2011年1月至2013年12月同济医院胸外科收治的15例气管良性狭窄患者的临床资料,男11例、女4例,年龄10~57(34.52±2.45)岁;均为气管内插管后发生狭窄,颈段气管良性狭窄13例,气管中段2例。6例患者行气管狭窄切除并端端吻合重建术,9例行气管狭窄切除端端吻合横行气管切开术。 结果本组15例患者均安全度过麻醉期和手术期,全组无手术死亡。术后发生切口感染及气胸各1例,所有患者均顺利出院。随访3~36个月,所有患者日常活动正常,无呼吸困难症状,无再狭窄发生。 结论气管良性狭窄的治疗首选气管袖式切除重建手术治疗,预防性气管切开利于术后呼吸道管理,减少并发症的发生。

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  • Progress on Diagnosis and Treatment of Congenital Tracheal Stenosis

    Congenital tracheal stenosis (CTS) is a rare but potentially life-threatening disease which results in congnital airway lesion. CTS is often associated with cardiovascular anomalies and presented with a wide spectrum of symptoms. CTS has challenged pediatric surgeons for decades. Various classic approaches and new techniques, including computational fluid dynamics, tissue-engineering trachea, and 3D printing have been proposed for diagnosis and treatment of CTS. This review provides a snapshot of the main progress of diagnosis and treatment of CTS.

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  • Mechanism of TGF-β/Smad Signaling Pathway Regulating Epithelial-mesenchymal Transition in Tracheal Stenosis after Transplantation

    ObjectiveTo investigate that the TGF- beta/Smad signaling pathway mediated epithelial mesenchymal transition (EMT) in trachea stenosis after transplantation. Methods180-220 g male rats (n=50) were randomly divided into a control group and an experimental group. no surgical operation rats were in the control group. tracheal transplantation rats (Wistar-SD rat) were in the experimental group. Graft specimens were obtained in rats on 3,7,10,14,35,90 days after operation. HE staining is used to explain the fibrosis degree of tracheal stenosis. The fibrosis degree of tracheal stenosis was detected by calculating the fibrosis rate. Immunohistochemical staining was used to detect transplanted tracheal, such as EMT related molecules E-cadherin, vimentin, alpha-SMA expression, p-Smad2/3 expression and transcription factor ZEB1, Snail1 expression in tracheal graft specimens. ResultsHE staining showed that the tracheal fibrosis rate of the control group was 0.171±0.020, fibrosis rate was 0.537±0.013 (P < 0.01) on the third day after transplantation. The result of immunohistochemical staining showed that vimentin positive epithelial cells increased significantly (P < 0.05). E-cadherin expression significantly reduced (P < 0.05). Compared with the control group, TGF- beta expression increased (P < 0.05) in the experiment group. Compared with the control group, the expression of p-Smad2/3, the transcription factor ZEB1 and Snail1 significantly increased (P < 0.05) in the experiment group. ConclusionMechanism of tracheal stenosis may be due to EMT. At the same time, TGF- beta/Smad signaling pathway and transcription factor ZEB1, Snail1 may regulate the EMT.

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  • Surgical Management of Bridging Bronchus Associated with Congenital Heart Disease and Tracheal Stenosis

    Objective To summarize our clinical experience of side-slide tracheoplasty in surgical management of bridging bronchus associated with congenital tracheal stenosis(CTS) and congenital heart disease (CHD). Method We retrospectively analyzed the clinical data of 8 bridging bronchus patients associated with CTS and CHD underwent tracheoplasty in our hospital from January 2010 through June 2015. There were 3 males and 5 females at age of 19.6±9.1 months and weight of 9.9±5.4 kg in our hospital. It was found that main tracheal associated with intermediate bronchus stenosis in 4 patients. Complete tracheal rings or bronchial rings were identified in all cases. Less than 50% normal tracheal size was found in all patients. Correction of CHD and tracheoplasty were done under cardiopulmonary bypass at the same stage. The technique of side-slide tracheoplasty was used in all patients. Results Average cardiopulmonary bypass time was 64.0±24.1 min. Average aortic clamp time was 14.0±18.1 min. No operative death occurred in hospital. The average duration of postoperative hospital stay was 20 d. Follow-up was completed in 8 patients. The duration of follow-up was 1 month to 5 years. Tracheal granulation occurred in one patient after six weeks of postoperation. The clinical symptoms improved significantly in the remaining patients. Conclusions Bridging bronchi has special anatomical features. The technique of side-slide tracheoplasty can be used to correct bridging bronchus associated with CTS with satisfactory outcomes.

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  • Surgical treatment of tracheal or bronchial stenosis related to severe congenital heart disease

    Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance (P>0.05). Left ventricular end-diastolic dimension (LVEDD) was decreased (P<0.05). Pulmonary artery pressure was lower (P<0.01). The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography (CTA) on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation (P<0.01). Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.

    Release date:2017-03-24 03:45 Export PDF Favorites Scan
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