颈段气管肿瘤切除与气管重建的研究进展

doi:10.3760/cma.j.cn101202-20230714-00178

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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5 285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。

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	郭梓昭
	王晓雷

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

Abstract：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, 5 285 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.

Key words： Tracheal neoplasms Cervical tracheal resection Reconstruction of trachea Tracheal transplantation Artificial trachea

收稿日期: 2023-07-14

基金资助:中国癌症基金会项目（CFC-XGB-202205）

通讯作者: 王晓雷,Email： wangxlchcams@163.com

引用本文:

郭梓昭, 王晓雷. 颈段气管肿瘤切除与气管重建的研究进展[J]. 中华解剖与临床杂志, 2024, 29(4): 277-282.
Guo Zizhao, Wang Xiaolei. Research progress on tumors resection and trachea reconstruction of cervical trachea. Chinese Journal of Anatomy and Clinics, 2024, 29(4): 277-282.

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http://www.cjac.com.cn/CN/10.3760/cma.j.cn101202-20230714-00178 或 http://www.cjac.com.cn/CN/Y2024/V29/I4/277

[1]	Grillo HC, Mathisen DJ.Primary tracheal tumors: treatment and results[J]. Ann Thorac Surg, 1990,49(1):69-77. DOI: 10.1016/0003-4975(90)90358-d.
[2]	Junker K.Pathology of tracheal tumors[J]. Thorac Surg Clin, 2014,24(1):7-11. DOI: 10.1016/j.thorsurg.2013.09.008.
[3]	Agrawal S, Jackson C, Celie KB, et al.Survival trends in patients with tracheal carcinoma from 1973 to 2011[J]. Am J Otolaryngol, 2017,38(6):673-677. DOI: 10.1016/j.amjoto.2017.08.005.
[4]	Honings J, Gaissert HA, van der Heijden HF, et al. Clinical aspects and treatment of primary tracheal malignancies[J]. Acta Otolaryngol, 2010,130(7):763-772. DOI: 10.3109/00016480903403005.
[5]	Wen J, Liu D, Xu X, et al.Nomograms for predicting survival outcomes in patients with primary tracheal tumors: a large population-based analysis[J]. Cancer Manag Res, 2018,10:6843-6856. DOI: 10.2147/CMAR.S186546.
[6]	Licht PB, Friis S, Pettersson G.Tracheal cancer in Denmark: a nationwide study[J]. Eur J Cardiothorac Surg, 2001,19(3):339-345. DOI: 10.1016/s1010-7940(01)00597-8.
[7]	Honings J, van Dijck JA, Verhagen AF, et al. Incidence and treatment of tracheal cancer: a nationwide study in the Netherlands[J]. Ann Surg Oncol, 2007,14(2):968-976.
[8]	Gaissert HA, Grillo HC, Shadmehr MB, et al. Long-term survival after resection of primary adenoid cystic and squamous cell carcinoma of the trachea and carina[J]. Ann Thorac Surg, 2004,78(6):1889-1896; discussion 1896-1897. DOI: 10.1016/j.athoracsur.2004.05.064.
[9]	Piórek A, Płużański A, Teterycz P, et al.Do we need TNM for tracheal cancers? Analysis of a large retrospective series of tracheal tumors[J]. Cancers (Basel), 2022,14(7):1665. DOI: 10.3390/cancers14071665.
[10]	Li J, Tan F, Wang Y, et al.Clinical characteristics, surgical treatments, prognosis, and prognostic factors of primary tracheal cancer patients: 20-year data of the National Cancer Center, China[J]. Transl Lung Cancer Res, 2022,11(5):735-743. DOI: 10.21037/tlcr-22-258.
[11]	Mallick S, Benson R, Giridhar P, et al.Demography, patterns of care and survival outcomes in patients with malignant tumors of trachea: a systematic review and individual patient data analysis of 733 patients[J]. Lung Cancer, 2019,132:87-93. DOI: 10.1016/j.lungcan.2019.04.017.
[12]	Chen K, Yang Z, Zhang X, et al.Clinical features and prognosis of primary tracheal small cell carcinoma: a population-based analysis[J]. Transl Cancer Res, 2020,9(2):882-890. DOI: 10.21037/tcr.2019.12.29.
[13]	Benissan-Messan DZ, Merritt RE, Bazan JG, et al.National utilization of surgery and outcomes for primary tracheal cancer in the United States[J]. Ann Thorac Surg, 2020,110(3):1012-1022. DOI: 10.1016/j.athoracsur.2020.03.048.
[14]	Brand-Saberi B, Schäfer T.Trachea: anatomy and physiology[J]. Thorac Surg Clin, 2014,24(1):1-5. DOI: 10.1016/j.thorsurg.2013.09.004.
[15]	吴静, 吴开乐, 刘业海, 等. 颈段气管缺损的术中处理方案[J].临床耳鼻咽喉头颈外科杂志,2021,35(5):453-456. DOI: 10.13201/j.issn.2096-7993.2021.05.016.Wu J, Wu KL, Liu YH, et al.Intraoperative treatment plan for cervical tracheal defect[J]. Journal of Clinical Otorhinolaryngology Head and Neck Surgery,2021,35(5):453-456. DOI: 10.13201/j.issn.2096-7993.2021.05.016.
[16]	温树信, 王斌全, 高伟, 等. 头颈恶性肿瘤外科切缘原则概念及临床应用[J].中华耳鼻咽喉头颈外科杂志,2019,54(9):704-707. DOI: 10.3760/cma.j.issn.1673-0860.2019.09.015.Wen SX, Wang BQ, Gao W, et al.Concept and clinical application of surgical margin principle on head and neck cancers[J].Chin J Otorhinolaryngol Head Neck Surg,2019,54(9):704-707. DOI: 10.3760/cma.j.issn.1673-0860.2019.09.015.
[17]	Udelsman B, Mathisen DJ, Ott HC.A reassessment of tracheal substitutes-a systematic review[J]. Ann Cardiothorac Surg, 2018,7(2):175-182. DOI: 10.21037/acs.2018.01.17.
[18]	沈子青, 夏天, 潘枢, 等. 血管化组织工程气管的研究进展[J].中华生物医学工程杂志,2022,28(6):697-703. DOI: 10.3760/cma.j.cn115668-20211202-00150.Shen ZQ, Xia T, Pan S, et al.Research progress in vascularized tissue engineering trachea[J].Chin J Biomed Eng, 2022, 28(6):697-703. DOI: 10.3760/cma.j.cn115668-20211202-00150.
[19]	Den Hondt M, Vranckx JJ.Reconstruction of defects of the trachea[J]. J Mater Sci Mater Med, 2017,28(2):24. DOI: 10.1007/s10856-016-5835-x.
[20]	Nyirjesy SC, Yu J, Dharmadhikari S, et al.Successful early neovascularization in composite tracheal grafts[J]. Otolaryngol Head Neck Surg, 2023,169(4):1035-1040. DOI: 10.1002/ohn.350.
[21]	Yao ZY, Feng BW, Liu CS, et al.The application of a bone marrow mesenchymal stem cell membrane in the vascularization of a decellularized tracheal scaffold[J]. Stem Cells Int, 2021,2021:6624265. DOI: 10.1155/2021/6624265.
[22]	Genden EM, Harkin T, Laitman BM, et al.Vascularized tracheal transplantation: a twenty month follow up[J]. Laryngoscope, 2023,133(8):1839-1845. DOI: 10.1002/lary.30444.
[23]	杨新明. 颈段气管肿瘤的外科处理[J].中国耳鼻咽喉颅底外科杂志,2016,22(4):257-260. DOI: 10.11798/j.issn.1007-1520.201604001.Yang XM.Surgical treatment of cervical tracheal tumors[J]. Chin J Otorhinolaryngol skull Base Surg,2016,22(4):257-260. DOI: 10.11798/j.issn.1007-1520.201604001.
[24]	赵薇, 田礼新, 鲍艳飞, 等. 青少年气管切除重建与螺纹管现象的临床诊治[J].中华结核和呼吸杂志,2014,37(2):144-145. DOI: 10.3760/cma.j.issn.1001-0939.2014.02.024.
[25]	朱少平, 王君钰, 徐明, 等. 颈段气管部分切除气管重建术19例临床分析[J].武汉大学学报(医学版),2020,41(3):505-507. DOI: 10.14188/j.1671-8852.2018.0762.Zhu SP, Wu JY, Xu M, et al.Artial resection and reconstruction of cervical trachea: 19-case report and clinical analysis[J].Medical Journal of Wuhan University,2020,41(3):505-507. DOI: 10.14188/j.1671-8852.2018.0762.
[26]	Broussard B, Mathisen DJ.Tracheal release maneuvers[J]. Ann Cardiothorac Surg, 2018,7(2):293-298. DOI: 10.21037/acs.2018.01.14.
[27]	Liu X, Dai J, Li J, et al.Video-assisted thoracoscopic hilar and pericardial release for long-segment tracheal resections[J]. J Thorac Dis, 2022,14(8):3061-3065. DOI: 10.21037/jtd-21-1866.
[28]	Xia X, Zhu XL, Zhu YY, et al.A novel classification of tracheal defects and the reconstruction strategies: a retrospective study based on 106 cases[J]. World J Otorhinolaryngol Head Neck Surg, 2023,9(1):66-73. DOI: 10.1016/j.wjorl.2021.08.001.
[29]	Ishida A, Hanai N, Oki M, et al.Successful resection of a primary dedifferentiated tracheal liposarcoma causing tracheal stenosis[J]. Intern Med, 2022,61(5):719-722. DOI: 10.2169/internalmedicine.6696-20.
[30]	李正江, 唐平章, 徐震纲. 颈段气管肿瘤的诊治经验[J].中华耳鼻咽喉头颈外科杂志,2006,41(3):208-210. DOI: 10.3760/j.issn:1673-0860.2006.03.013.Li ZJ, Tang PZ, Xu ZG.Experience of diagnosis and treatment for primary cercival tracheal tumors[J]. Chin J Otorhinolaryngol Head Neck Surg,2006,41(3):208-210. DOI: 10.3760/j.issn:1673-0860.2006.03.013.
[31]	Tovi F, Gittot A.Sternocleidomastoid myoperiosteal flap for the repair of laryngeal and tracheal wall defects[J]. Head Neck Surg, 1983,5(5):447-451. DOI: 10.1002/hed.2890050510.
[32]	Ren J, Xu Y, Zhiyi G, et al.Reconstruction of the trachea and carina: surgical reconstruction, autologous tissue transplantation, allograft transplantation, and bioengineering[J]. Thorac Cancer, 2022,13(3):284-295. DOI: 10.1111/1759-7714.14315.
[33]	温树信, 张庆丰, 王鑫, 等. 头颈恶性肿瘤的整块切除与微创手术[J].中华耳鼻咽喉头颈外科杂志,2020,55(11):1077-1079. DOI: 10.3760/cma.j.cn115330-20200420-00313.Wen SX, Zhang QF, Wang X, et al.En bloc resection and minimally invasive surgery for head and neck cancers[J]. Chin J Otorhinolaryngol Head Neck Surg,2020,55(11):1077-1079. DOI: 10.3760/cma.j.cn115330-20200420-00313.
[34]	杨丹, 但红霞. 肿瘤光动力疗法抵抗机制的研究进展[J].中华实验外科杂志,2023,40(2):391-396. DOI: 10.3760/cma.j.cn421213-20220714-00534.Yang D, Dan HX.Research progress in resistance mechanism of tumor photodynamic therapy[J].Chinese Journal of Experimental Surgery,2023,40(2):391-396. DOI: 10.3760/cma.j.cn421213-20220714-00534.
[35]	Miles ER, Krishna PD, Dehom S, et al. Voice and airway outcomes of Montgomery T-tube placement in laryngotracheal stenosis[J]. J Voice, 2022: S0892-1997(22)00161-00168. DOI: 10.1016/j.jvoice.2022.06.009.
[36]	Kao YH, Pan YA, Lee KS, et al.Montgomery T-tube airway restoration and swallowing rehabilitation for a near-hanging female[J]. Ear Nose Throat J, 2022:1455613221115136. DOI: 10.1177/01455613221115136.
[37]	徐勇, 高二击, 段亮, 等. 基于组织工程技术修复节段性气管缺损的研究进展[J].中华外科杂志,2022,60(1):104-109. DOI: 10.3760/cma.j.cn112139-20210206-00073.Xu Y, Gao EJ, Duan L, et al.progress of circumferential tracheal reconstruction via tissue-engineered trachea[J].Chin J Surg,2022,60(1):104-109. DOI: 10.3760/cma.j.cn112139-20210206-00073.
[38]	Bergman M, Harwood J, Liu L, et al.Optimization of chondrocyte viability in partially decellularized tracheal grafts[J]. Otolaryngol Head Neck Surg, 2023,169(5):1241-1246. DOI: 10.1002/ohn.404.
[39]	Rose KG, Sesterhenn K, Wustrow F.Tracheal allotransplantation in man[J]. Lancet, 1979,1(8113):433. DOI: 10.1016/s0140-6736(79)90902-4.
[40]	Klepetko W, Marta GM, Wisser W, et al.Heterotopic tracheal transplantation with omentum wrapping in the abdominal position preserves functional and structural integrity of a human tracheal allograft[J]. J Thorac Cardiovasc Surg, 2004,127(3):862-867. DOI: 10.1016/j.jtcvs.2003.07.050.
[41]	Delaere P, Vranckx J, Verleden G, et al.Tracheal allotransplantation after withdrawal of immunosuppressive therapy[J]. N Engl J Med, 2010,362(2):138-145. DOI: 10.1056/NEJMoa0810653.
[42]	Genden EM, Miles BA, Harkin TJ, et al.Single-stage long-segment tracheal transplantation[J]. Am J Transplant, 2021,21(10):3421-3427. DOI: 10.1111/ajt.16752.
[43]	崔鹏程. 气管移植研究进展[J].中华耳鼻咽喉头颈外科杂志,2018,53(1):73-75. DOI: 10.3760/cma.j.issn.1673-0860.2018.01.019.Cui PC.Advances in tracheal transplantation[J]. Chin J Otorhinolaryngol Head Neck Surg,2018,53(1):73-75. DOI: 10.3760/cma.j.issn.1673-0860.2018.01.019.
[44]	Martinod E, Paquet J, Dutau H, et al.In vivo tissue engineering of human airways[J]. Ann Thorac Surg, 2017,103(5):1631-1640. DOI: 10.1016/j.athoracsur.2016.11.027.
[45]	Fabre D, Kolb F, Fadel E, et al.Successful tracheal replacement in humans using autologous tissues: an 8-year experience[J]. Ann Thorac Surg, 2013,96(4):1146-1155. DOI: 10.1016/j.athoracsur.2013.05.073.
[46]	Fabre D, Fadel E, Mussot S, et al.Autologous tracheal replacement for cancer[J]. Chin Clin Oncol, 2015,4(4):46. DOI: 10.3978/j.issn.2304-3865.2015.12.07.
[47]	Mercier O, Kolb F, Dartevelle PG.Autologous tracheal replacement: surgical technique and outcomes[J]. Thorac Surg Clin, 2018,28(3):347-355. DOI: 10.1016/j.thorsurg. 2018.05.007.
[48]	Liu L, Dharmadhikari S, Spector BM, et al.Tissue-engineered composite tracheal grafts create mechanically stable and biocompatible airway replacements[J]. J Tissue Eng, 2022,13:20417314221108791. DOI: 10.1177/20417314221108791.
[49]	Macchiarini P, Jungebluth P, Go T, et al.Clinical transplantation of a tissue-engineered airway[J]. Lancet, 2008,372(9655):2023-2030. DOI: 10.1016/S0140-6736(08)61598-6.
[50]	Arnason G.Regulating clinical innovation: trachea transplants and tissue engineering[J]. Am J Bioeth, 2019,19(6):32-34. DOI: 10.1080/15265161.2019.1602179.
[51]	Torjesen I.Lancet will not retract discredited paper on tissue engineered trachea transplants[J]. BMJ, 2022,376:o600. DOI: 10.1136/bmj.o600.
[52]	Schneider L, Murray P, Lévy R, et al.Time to retract Lancet paper on tissue engineered trachea transplants[J]. BMJ, 2022,376:o498. DOI: 10.1136/bmj.o498.
[53]	Liu L, Dharmadhikari S, Shontz KM, et al.Regeneration of partially decellularized tracheal scaffolds in a mouse model of orthotopic tracheal replacement[J]. J Tissue Eng, 2021,12:20417314211017417. DOI: 10.1177/20417314211017417.
[54]	Les AS, Ohye RG, Filbrun AG, et al.3D-printed, externally-implanted, bioresorbable airway splints for severe tracheobronchomalacia[J]. Laryngoscope, 2019,129(8):1763-1771. DOI: 10.1002/lary.27863.
[55]	刘春全, 李华伟, 蔡先启, 等. 3D打印复合人工气管移植的实验研究[J].临床和实验医学杂志,2018,17(4):350-354. DOI: 10.3969/j.issn.1671-4695.2018.04.005.Liu CQ, Li HW, Cai XQ, et al.Experimental study of 3D printing composite artificial trachea transplantation[J].Journal of Clinical and Experimental Medicine,2018,17(4):350-354. DOI: 10.3969/j.issn.1671-4695.2018.04.005.
[56]	Gao M, Zhang H, Dong W, et al.Tissue-engineered trachea from a 3D-printed scaffold enhances whole-segment tracheal repair[J]. Sci Rep, 2017,7(1):5246. DOI: 10.1038/s41598-017-05518-3.
[57]	Xu Y, Guo Z, Liu R, et al.Bioengineered carina reconstruction using In-Vivo Bioreactor technique in human: proof of concept study[J]. Transl Lung Cancer Res, 2020,9(3):705-712. DOI: 10.21037/tlcr-20-534.