頚部気管再建

Abstract

Treatment of diseases of the upper trachea by surgical resection and reconstruction may impair quality of life (QOL) because of the anatomically close relation between the trachea and larynx. We studied factors which determine QOL after tracheal reconstruction by analyzing cases who underwent upper tracheal and/or laryngeal resection and reconstruction.We studied 99 tracheal-lesion cases who had had tracheobronchial reconstruction. There were 61 thyroid carcinomas invading the trachea and/or larynx, 10 primary tracheal tumors, one esophageal tumor invading the trachea, four metastatic tracheal tumor, 22 benign tracheal stenoses, and one congenital tracheal stenoses.Among these 99 cases, 30 cases showed tumor invasion of the cricoid cartilage which required a partial resection. After this operation, 7 cases developed complications (4 had partial dehiscence of the anastomosis; and 3 a stenotic change in the anastomosis). Because of the involvement of the recurrent nerve in the tumors, 19 cases developed bilateral recurrent nerve palsy. Since bilateral recurrent nerve palsy causes serious impairment of QOL, we treated those patients with fenestration and/or tracheostomy in initial cases, and with insertion of a T-tube in later cases. When the oral end of the T-tube was placed just above the vocal cords, breathing, phonation and swallowing were maintained, although hoarseness persisted. The T-tube was successfully removed in thirteen cases when the vocal cords had been fixed to a juxta-lateral position 6 to 18 months after insertion.Regarding survival in case of thyroid carcinoma invading the trachea, complete resection is superior to incomplete resection, however, total laryngectomy impairs QOL so much that a maximum effort should be made to avoid total laryngectomy.