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.
ObjectiveTo evaluate the difference between the tracheal intubation connected to conventional ventilation (TI-CV) and rigid bronchoscopy connected to high frequency ventilation (RB-HFV) under general anesthesia on patients with transbronchial cryobiopsy (TBCB).MethodA prospective, randomized, controlled trial was conducted in interstitial lung disease patients with TBCB from August 2018 to February 2019 in the First Affiliated Hospital of Guangzhou Medical University. According to the different methods of intubation, the patients were divided to a TI-CV group and a RB-HFV group randomly. The operating duration, extubation duration, total anesthesia time, heart rate, blood pressure and arterial blood gas analysis were collected and analyzed.ResultsSixty-five patients were enrolled. There were 33 patients with an average age of (48.0±15.0) years in TI-CV group and 32 patients with an average age of (48.8±10.8) years in RB-HFV group. The basic line of body mass index, pulmonary function (FEV1, FVC and DLCO), arterial blood gas (pH, PaO2 and PaCO2) and heart rate (HR), mean arterial pressure (MAP) had no significant differences between two groups. At the first 5 minutes of operation, the pH was (7.34±0.06) and (7.26±0.06), and the PaCO2 was (48.82±9.53) and (62.76±9.80) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P=0.000). At the end of operation, the pH was (7.33±0.06) and (7.21±0.08), the PaCO2 was (48.91±10.49) and (70.93±14.83) mm Hg, the HR were (79.6±21.1) and (93.8±18.7) bpm, the MAP were (72.15±13.03) and (82.63±15.65) mm Hg in TI-CV group and RB-HFV group respectively, with significant differences (P<0.05). There were no differences in the operating duration and extubation duration between two groups. The total anesthesia time was (47.4±8.8) and (53.3±11.6) min with significant difference (P=0.017). Five minutes after the extubation, there were no significant difference in the pH, PaO2, PaCO2, HR and MAP between two groups. No serious complications occurred in either group.ConclusionsCompared with rigid bronchoscopy, TI-CV under general anesthesia is more conducive to maintain effective ventilation, and maintain the HR and MAP stable during the TBCB procedure. TBCB procedure should be performed by TI-CV under general anesthesia in patients with poor cardiopulmonary function.
Objective To study the surgical treatment of tracheal and main bronchial tumors. Methods We retrospectively analyzed the clinical data of 30 patients with tracheal and main bronchial tumors treated in Shengjing Hospital of China Medical University from January 2000 to December 2015. There were 12 males and 18 females with the age ranging from 22 to 80 years. Results Ten patients were treated with enucleation, 12 patients tracheal tumor resection and end-to-end anastomosis, 1 patient window resection, 1 patient wedge resection, 5 patients tumor resection and tracheal reconstruction by using pulmonary tissue flap with alloy stent and 1 patient left pneumonectomy. One patient died of sudden massive hemoptysis 26 d after operation. Intraoperative complications were found in 2 patients. Others had a good recovery after operation. Patients were followed up for 11 months to 14 years. Eight patients were followed up less than 5 years postoperatively, one patient died of sudden massive hemoptysis 14 months after operation, while others survived; 21 patients were followed up more than 5 years and 5 patients were lost to follow-up. Conclusion Surgical resection is recommended for tracheal and main bronchial tumors. Patients with small benign tumor may choose local tracheal resection; tracheal segmental resection and end-to-end anastomosis is the most common surgical treatment. Patients with more than half of the whole length of tracheal defects or in the risk of anastomotic ischemic necrosis may be suggested to receive tracheal reconstruction.
ObjectiveTo explore the clinical features, diagnosis, differential diagnosis, pathological characteristics, management and prognosis of airway hemangioma, and improve the level of the diagnosis and therapy.MethodsThe clinical data of a patient with airway hemangioma admitted to West China Hospital of Sichuan University were retrospectively analyzed. The related literatures were reviewed. Databases including PubMed, Ovid Medline, Embase, VIP, Wanfang and Chinese National Knowledge infrastructure were searched using the keywords as " Trachea” OR " Bronchus” AND " Hemangioma” from January 1976 to October 2016.ResultsThe patient was a 32-year-old male presented with hemoptysis and backache more than 10 days. His enhanced chest CT scan revealed thickening of the esophagus wall and narrowing of the lumen of esophagus. A wide range of vascular tumor like changes in the trachea and the two sides of bronchus were found by the fiberoptic bronchoscopy and gastroscope examination suggested esophageal varices. Although the patient had a wide range of airway lesions, the symptom of hemoptysis was relieved after the conservative treatment. The patient’s condition was stable until now. From January 1976 to October 2016, a total of 34 related articles were retrieved and 36 cases of airway hemangioma were reported. The etiology of the disease remains unknown. Recurrent hemoptysis was the common symptoms of airway hemangioma, and imaging changes lacking characteristics. Histopathological examination revealed dilated, thin-walled and different size of vascular or hyperplastic capillary and immunohistochemical staining was positive for vascular endothelial cell specific CD34 and Ⅷ factor.ConclusionsHemangioma is a common benign tumor of head and neck in infants and children. Hemangioma is very rarely occurred in trachea in adults. Clinical and imaging manifestations are not specific, and diagnosis relies on histopathological examination. Fiberoptic bronchoscopy and three dimensional reconstruction of thoracic vessels with CT play important roles in the whole process of diagnosis and treatment of airway hemangioma. It should be differentiated from lymphangioma. The prognosis of airway hemangioma is good.
Tissue engineering trachea is an artificial trachea with biological activity, which is constructed in vitro by using tissue engineered principle and technology, and is a tracheal prosthesis for replacing large circumferential defect of the trachea. The course of its construction is as follows. First, seeding cells are cultured and expanded in vitro. Then they are collected, counted and seeded onto the biomaterial scaffold of tissue consistent and biodegradation. Finally, the biomaterial-cells construction is implanted into bio-reaction device or one’s subcutaneous layer. The tissue engineering trachea could be constructed after cultured certain times. Compared with other artificial trachea, the tissue engineering trachea has more advantages, such as nonimmunogenicity, no side-effects related to foreign graft materials, and biologic activity. This will bring some hope to look for an appropriate graft material. However, the study about it is still faced with some difficult problems, such as vascularized trachea, culturing in vitro, and prevention of infection in trachea prosthesia. So there will be long time for tissue engineering trachea to apply clinical tracheal transplantation successfully. This assay has reviewed the study about tissue engineering trachea from three sides——the source of seeding cells, the research about biomaterial scaffold, and the construction of tissue engineering trachea.
Tissue-engineered tracheal transplantation has been reported and the technique of decellularized scaffold's preparation is mature. Regeneration of epithelium, cartilage and blood vessel is particularly important during tracheal transplantation. With the increasing improvement on cell acquisition and cell culture, as well as the factor of auxesis and cell differentiation, tissue-engineered technique provided possibility and clinical value for regeneration of epithelium, cartilage and blood vessel. This review focuses on the improvement and prospect of regeneration of epithelium, cartilage and blood vessel during tracheal transplantation.
ObjectiveTo observe the morphological and pathological changes after transplantation of polytetrafluoroethylene (PTFE) in vivo. MethodsPTFE microporous polypropylene tube which was encircled by spiral steel wire was used to prepare the artificial trachea.Forty New Zealand white rabbits (weighing,4-5 kg) were selected,and were divided into 2 groups.After the cervical trachea (2 cm in length) was removed,the end-to-end anastomosis between the trachea and PTFE artificial trachea was performed in the experimental group (n=20),and end-to-end anastomosis of the trachea in the control group (n=20).The survival of the rabbits was observed after operation;the X-ray,gross,and histological observations were carried out at 2,4,and 6 months after operation.The longitudinal tensile and radial support biomechanical tests were performed before and after transplantation. ResultsThe survival time was more than 2 months and the artificial airway was patency in 15 rabbits of the experimental group;the tissue outside the artificial trachea was like tracheal tissue,which filled in the defect,but it was more than 4 months.X-ray observation showed that the PTFE artificial trachea had no obvious displacement in the experimental group,and no tracheostenosis was observed in the control group.After 2 months,there was no epithelial tissue on the artificial airway wall;after 4 months,there was some epithelial cells on the artificial airway wall,incomplete endothelialization and trachea layer structure were seen with no tracheal ciliated columnar epithelium;after 6 months,the artificial trachea wall was covered with epithelium basically,and some ciliated columnar epithelium cells were found,which had the physiological function of the trachea.The transplanted PTFE artificial trachea could keep the stability of the biological mechanics performance,and could be used for the rabbit tracheal reconstruction. ConclusionPTFE artificial trachea can induce to form a tracheal tissue in the trachea tissues of recipients,each layer of the trachea is relatively complete and the experiment animals can be short-term survival.
Objective To investigate the current situation of salivation in patients with orotracheal cannula, and to systematically analyze its influencing factors. Methods Patients who underwent tracheal intubation treatment in 47 tertiary comprehensive medical institutions were selected between October 10th and 20th, 2023. A cross-sectional survey method was used to conduct an online survey of the patient’s salivation status. The patients were divided into the salivation group and no-salivation group. Results A total of 565 questionnaires were collected and 561 were valid, with an effective recovery rate of 99%. Among 561 patients, 284 were males (50.62%) and 277 were females (49.38%), with an age of (59.80±10.96) years; 159 cases of salivation occurred, with a total static saliva flow rate of (7.21±3.15) mL and the incidence of salivation was 28.34% (159/561). There were statistically significant differences in age, education level, body mass index, primary disease, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days, intubation depth, intubation process, sedation and/or analgesia days, and enteral nutrition treatment between the two groups (P<0.05). There was no statistically significant difference in other indicators between the two groups (P>0.05). The results of multivariate logistic regression analysis showed that body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process were independent risk factors for salivation in patients with oral catheterization. Conclusion The incidence of salivation in patients with orotracheal cannula is 28.34%, which is directly related to body mass index, neurological diseases, number of concurrent functional impairments, concurrent oral diseases, smoking, intubation days and intubation process.
ObjectiveTo analyze the trend of disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021 and predict its future changes. MethodsData was extracted from the Global Burden of Disease Database 2021 to analyze the disease burden of tracheal and bronchial lung cancer in China from 1990 to 2021. The Joinpoint regression model was used to analyze the temporal trends. The BAPC model was employed to predict the future disease burden of tracheal and bronchial lung cancer in China. ResultsIn 2021, the standardized incidence rate, standardized prevalence, standardized mortality rate, and standardized DALYs rate of tracheal and bronchial lung cancer in China were 44.01/100 000, 57.95/100 000, 38.98/100 000, and 878.25/100 000, all of which showed an upward trend compared to 1990, with the standardized prevalence increasing the fastest at 71.75%, followed by the standardized incidence rate, which increased by 32.93%. BAPC prediction results indicated that the standardized incidence and prevalence rates of tracheal and bronchial lung cancer in the Chinese population will show an upward trend, while the standardized mortality rate will show a downward trend, and the standardized DALYs rate will remain relatively stable from 2022 to 2035. The standardized incidence rate is expected to rise from 46.18/100 000 in 2022 to 50.32/100 000 in 2035, the standardized prevalence rate is expected to rise from 60.47/100 000 in 2022 to 73.49/100 000 in 2035, the standardized mortality rate is expected to decrease from 39.75/100 000 in 2022 to 36.53/100 000 in 2035, and the standardized DALYs rate is expected to rise from 903.25/100 000 in 2022 to 916.38/100 000 in 2035. ConclusionFrom 1990 to 2021, the disease burden of tracheal and bronchial lung cancer in China showed an upward trend. Although the disease burden among the elderly and males is more prominent, the rate of increase among females in the past decade has been rapid and shows a trend towards younger ages. Comprehensive prevention and control measures should be taken. It is predicted that the situation of tracheal and bronchial lung cancer incidence and prevalence in China will remain very serious from 2022 to 2035.
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.