OBJECTIVE: To compare the effect of several types of rib rings with intercostal muscles for the replacement of trachea in thorax. METHODS: The surface layer of the third rib of dogs were ripped off and curved into triangular, quadrilateral and polygonal form. These three types of rib rings with intercostal muscles were used to replace a segment of trachea in thorax. RESULTS: The stability of triangular rib ring was very well, but stricture of ring were often happened because of its smaller internal diameter. These stability of quadrilateral rib ring was the worst. The polygonal rib ring presented the biggest diameter and good stability compared to the other two kinds of rings. If silicone tube was supplemented in the polygonal rib ring, the quality of artificial trachea was excellent. CONCLUSION: The rib rings with intercostal muscles are successfully used for replacing the defect of trachea in canine thorax. The polygonal rib rings have the best quality in the three types of rib ring for tracheal replacement.
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 bipedicledsternohyoid 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 antiinfection and survival rate, and stable structure. A combination of epiglottic and the bipedicled sternohyoid myofascial flap plus sternocleidomastoideus clavicle membrane flap can repair large laryngeal and tracheal defects.
In tracheal resection and reconstruction, a technically demanding, complex, and high-risk procedure, management of the anastomotic site significantly impacts postoperative outcomes and long-term quality of life. However, comprehensive studies detailing perioperative anastomotic management strategies in tracheal reconstruction remain scarce. This review summarizes perioperative management strategies for tracheal reconstruction, covering preoperative assessment, surgical techniques, and other key aspects. It also highlights future research directions and challenges, aiming to provide clinicians with a systematic guide to perioperative management in tracheal reconstruction.
Tracheal stents are often used to maintain the patency of the trachea and bronchia in patients suffering from central airway lesions. Metallic tracheal stents are now widely used in the clinical setting, but these types of stents can cause many intractable material-related complications. Biodegradable tracheal stents are made of biodegradable polymer materials with good mechanical strength for maintaining the patency of the lesion segment during a certain period of time, and then they can be gradually degraded into harmless products in human body. Compared with conventional metallic tracheal stent, biodegradable tracheal stents have a good prospect in clinic. In this article, we review the choice of biodegradable tracheal stent materials, experimental progress in biodegradable tracheal stent as well as the challenges we are facing.
Objective To study the research advance in tracheal allografts undergoing revascularization and reepithelialization. Methods Therecent literature concerned was reviewed. The tracheal allografts are embedded in the omentum, which they were revascularized and reepithelialized by planting in self-epithelia, then the allografts with their omental pedicles were transplanted orthotopically to the cervical or the thoracic portion of the trachea. Results Compared withthe onestage tracheal allograft approach using the greater omentum, the twostage approach could increase the successful rate of revascularization and reepithelialization, and made the allografts accord with their physiology. Conclusion If the approach is successful, it can reduce graft-rejection, prevent graft-collapse and increase graft-viability after tracheal allograft.
Objective To review the recent research progress of base and clinical application of tracheal replacement. Methods Literature concerning tracheal prosthesis and the current achievements were extensively and comprehensively reviewed. Results Most tracheal lesions can be resected and achieve primary reconstruction, but the resectable length was limited.Tracheal replacement was an efficient and feasible way to substitutethe defects resulting from extended resection. Conclusion Newtechniques such as tissue engineering, tracheal transplantation, new tracheal prosthesis of biomaterials break fresh ground for the more rapid development of tracheal surgery.
Objective To construct a new composite artificial trachea and to investigate the feasibility of trachea repair and reconstruction with the new composite artificial trachea transplantation in dogs. Methods The basic skeleton of the new composite artificial trachea was polytetrafluoroethylene vascular prosthesis linked with titanium rings at both ends. Dualmesh was sutured on titanium rings. Sixteen dogs, weighing (14.9 ± 2.0) kg, female or male, were selected. The 5 cm cervical trachea was resected to prepare the cervical trachea defect model. The trachea repair and reconstruction was performed with the new composite artificial trachea. Then fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction were conducted at immediate, 1 month, and 6 months after operation. Gross observation and histological examination were conducted at 14 months to evaluate the repair and reconstruction efficacy. Results No dog died during operation of trachea reconstruction. One dog died of dyspnea at 37, 41, 55, 66, 140, and 274 days respectively because of anastomotic dehiscence and artificial trachea displacement; the other 10 dogs survived until 14 months. The fiberoptic bronchoscope examination, CT scan and three-dimensinal reconstruction showed that artificial tracheas were all in good location without twisting at immediate after operation; mild stenosis occurred and anastomoses had slight granulation in 6 dogs at 1 month; severe stenosis developed and anastomosis had more granulation in 1 dog and the other dogs were well alive without anastomotic stenosis at 6 months. At 14 months, gross observation revealed that outer surface of the artificial trachea were encapsulated by fibrous connective tissue in all of 10 dogs. Histological examination showed inflammatory infiltration and hyperplasia of fibrous tissue and no epithelium growth on the inner wall of the artificial trachea. Conclusion The new composite artificial trachea can be used to repair and reconstruct defect of the trachea for a short-term. Anastomotic infection and dehiscence are major complications and problems affecting long survival.
Abstract： Objective To investigate the methods of diagnosis and treatment for early and late cheobronchial rupture, in order to improve the understanding of this disease. Methods We retrospectively analyzed the records of 19 patients treated for traumatic tracheobronchial rupture in our hospital between October 1988 and August 2010. There were 9 males and 10 females with a median age of 28 years (ranged from 8 to 48 years). We analyzed the clinical characteristics of the disease, including clinical presentation, and the results of chest Xrays, computed tomography（CT）, and fibrobronchoscopy. There were 2 cases of tracheal repair, 1 case of tracheostomy, 8 cases of bronchial reconstruction, 7 cases of bronchial repair, and 1 case of pneumonectomy. Results Seventeen patients were cured by operation and 2 patients died of multiple organ failure. Blood oxygen saturation resumed normal in most patients after operation (9680%±159% vs. 8840%±390%，Plt;0.01). Postoperative followup time was ranged from 3 to 24 months, and no tracheobronchial stenosis was observed and no patients needed stent or dilatation for treatment. Conclusion The diagnosis of tracheobronchial rupture depends on history of trauma, chest Xray, CT and fibrobronchoscopy results. Surgical treatments should be based on the tracheobronchial reconstruction or repair, and the clinical outcome is satisfying.
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.
Objective To evaluate the clinical features and complications of bedside tracheal intubation in intensive care unit ( ICU) , and explore the suitable strategy of intubation. Methods In this retrospective study,42 patients who underwent bedside tracheal intubation in ICU during September 2008 and March 2009 were divided into a schedule group ( n =24) and an emergency group ( n =18) . The time to successful intubation, number of intubation attempts, and complications were recorded. The schedule group was defined as those with indications for intubation and fully prepared, while the emergency group was defined as those undergoing emergency intubations without full preparation due to rapid progression of disease and accidental extubation. Results The success rate for all patients was only 57. 1% on the first attempt ofintubation. The main complications during and after induction were hypotension ( 45. 2% ) and hypoxemia ( 50. 0% ) . Compared with the emergency group, the schedule group had fewer attempts to successful intubation ( 1. 71 ±1. 12 vs. 2. 67 ±1. 75) , higher success rate on the second attempt ( 87. 5% vs.61. 1%) , and lower ypoxemia incidence ( 29. 1% vs. 77. 8%, P lt; 0. 05) . Conclusions The tracheal intubation in ICU is a difficult and high risk procedure with obvious complications. Early recognition ofpatients with indications and well preparation are critical to successful bedside intubation.