摘要
目的探讨颈段气管肿瘤切除与气管重建策略及其研究进展。方法在中国知网、中华医学期刊全文数据库、万方数据库,以及PubMed、SinoMed等中、英文数据库中检索2023年3月之前发表的有关颈段气管肿瘤切除及颈段气管重建研究的文献共5285篇。排除重复的检索结果,以及内容相关性较低、无法获取全文、质量较低和缺乏创新性的文献,最终纳入57篇文献,通过分析并结合临床实践经验,总结不同颈段气管外科治疗方式的优缺点、技术细节及适用范围。结果对于颈段气管肿瘤的外科治疗,在切除肿瘤的同时保持气道完整性至关重要,其挑战性在于如何精准地把控颈段气管的生理特性、解剖血供特点及吻合口张力程度,同时采取恰当的气道重建策略。颈段气管肿瘤的外科手术方式(包括肿瘤切除和气道重建方式)依其浸润范围分为短节段气管外科治疗和长节段气管外科方法:侵犯气管纵向长度≤5 cm、环周范围≤50%的短节段气管肿瘤(切除后气管缺损长度≤6 cm)的外科术式已基于不同适应证形成了较为固定的模式,如气管袖状切除端端吻合术、气管窗式切除缺损处拉拢缝合或组织瓣修复术、经内镜局部切除术等,气管移植和人工气管的发展为需要修补长节段气管缺损(长度>6 cm)的复杂病例提供了潜在的解决方案。结论以手术为主的综合治疗是当前颈段气管肿瘤治疗的主要模式,个体化治疗与多学科合作对于颈段气管肿瘤的根治性切除以及气管正常生理功能的重建具有关键作用。
Objective This study explores the research progress on the surgical resection of cervical tracheal tumors and the reconstruction of cervical trachea.Methods In the Chinese and English databases,such as CNKI,China Medical Journal Full-text Database,Wanfang,SinoMed,and PubMed,5285 articles on cervical tracheal tumors and cervical tracheal reconstruction published before March 2023 were searched.At total of 57 articles were included after duplicates and articles with low relevance,unavailability,low quality,or lack of innovation were excluded.The selected articles were analyzed to summarize various surgical techniques,and on the basis of clinical experience,the advantages,technical details,and applicability of different surgical approaches for cervical tracheal tumors were explored.Results For the surgical treatment of cervical tracheal tumors,completely removing the tumor while maintaining airway integrity was essential.The main surgical challenge lies in the reconstruction of the airway after complete tumor resection,and some scholars achieved localized improvements in recent years.The key factors in cervical tracheal surgery include the physiological characteristics of the trachea,the anatomical vascular supply,and the control of anastomotic tension.The surgical methods of cervical tracheal tumors,including tumor resection and airway reconstruction,were divided into short-and long-segment surgical treatments in accordance with the extent of invasion.The surgical treatment of short segmental tracheal tumors(length of tracheal defect after resection≤6 cm)with length≤5 cm and tracheal circumference≤50%formed a relatively fixed model on the basis of different indications,including sleeve resection with end-to-end anastomosis,window-type tracheal resection,and endoscopic local resection.The development of tracheal transplantation and artificial trachea technology provides potential solutions for complex cases involving long-segment tracheal defects(length>6 cm).Conclusion Comprehensive treatment based on surgery is the main treatment mode for cervical tracheal tumor.Personalized treatment and multidisciplinary cooperation play a pivotal role in the radical resection of cervical tracheal tumors and the reconstruction of the normal physiological function of the trachea.
作者
郭梓昭
王晓雷
Guo Zizhao;Wang Xiaolei(Department of Head and Neck Surgery,National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital,Chinese Academy of Medical Sciences and Peking Union Medical College,Beijing 100021,China)
出处
《中华解剖与临床杂志》
2024年第4期277-282,共6页
Chinese Journal of Anatomy and Clinics
基金
中国癌症基金会项目(CFC-XGB-202205)。
关键词
气管肿瘤
颈段气管切除
气管重建
气管移植
人工气管
Tracheal neoplasms
Cervical tracheal resection
Reconstruction of trachea
Tracheal transplantation
Artificial trachea
