人工気管による気道再建術

Abstract

Because of the limitation of tracheal resection in the primary end-to-end. anastomotis, there is a necessity of prosthetic reconstruction.We performed prosthetic reconstruction of the airway since 1979. We used straight type of Neville prosthesis in 5 patients, bifurcated type of Neville prosthesis in 2 patients and Katsura prosthesis in 3 patients. Five patients were operated for lung cancer (squamous cell carcinoma) extending to carina and trachea, 2 patients for adenoid cystic carcinoma of the trachea, and the others each for large cell carcinoma, thyroid cancer and tuberculous granuloma.Circumferential resection of the trachea was performed in 4 patients, right sleeve pneumonectomy in 4 patients and resection of the carina in 2 patients. One patient died of cardiac insufficiency from intraoperative ventilatory failure at 2 days, 1 patient died of recurrent cancer at 3 months and 1 patient died of accidental cardiac attack at 4 months postoperatively.The postoperative complications related to the prosthesis occurred in 7 patients. Four patients died of the complications; 1 tracheo-innominate arterial fistula after 1 month, 1 suture insufficiency at the anastomotic site due to uncontrollable diabetes mellitus after 40 days, 2 migrations of prosthesis after 15 months. In spite of dehiscence and granulation at the anastomotic site 1 patient died of an accident after 25 months and 1 patient died of multiple metastases after 43 months. One patient is alive with slight granulation at the proximal anastomotic site for 5 months.Prosthetic reconstruction of the airway has the advantage with regard to the possibility for extending the resectable limitation and easiness for operative procedure, but there are problems of prosthetic migration and granulation at the anastomotic site.The patients easily expectorated sputa by coughing after the prosthetic reconstruction.We produced Katsura prosthesis with elasticity and flexibility for the purpose of improving Neville prosthesis.