Background: Tracheo-carinal resection and reconstruction in cases of extensive malignant tumors present a significant surgical challenge, often complicated by high anastomotic tension and potential for incomplete anastomosis.

Case description: We report on a 45-year-old male with a primary adenoid cystic carcinoma. The tumor was about 3 cm in size and invaded about 1 cm of the lower trachea, 2 cm of the left main bronchus (LMB), and 1 cm of the right main bronchus (RMB), blocking about 70% of the tracheal lumen, 90% of the LMB, and 50% of the RMB. Resection of the lower trachea and part of the LMB and RMB was performed via the right chest. We used the right main bronchial flap as a bridge, suturing it separately to the lower tracheal segment and the LMB, thereby completing the carinal reconstruction. This technique was crucial for bridging the defect between the trachea and LMB, which was impossible to anastomose directly due to the tumor's extensive involvement. The elliptical-shaped lingual flap from the RMB provided a stable and tension-free foundation for the reconstruction, overcoming the limitations of conventional methods.

Conclusions: The novel carinal reconstruction technique demonstrated a reliable alternative for complex tracheo-carinal defects, ensuring tension-free anastomosis and complete tumor resection with clear margins.

Keywords: Case report; adenoid cystic carcinoma; bronchial flap; carinal reconstruction; tracheal tumors.

2024 Translational Lung Cancer Research. All rights reserved.

背景： 在广泛恶性肿瘤的情况下进行气管-隆嵴切除和重建是一项重大的手术挑战，常常由于高吻合张力和可能的不完全吻合而变得复杂。

病例描述： 我们报告了一例45岁男性的原发性腺样囊性癌。肿瘤大小约为3厘米，并侵入了气管下端约1厘米，左主支气管（LMB）2厘米和右主支气管（RMB）1厘米，导致气管腔阻塞约70%，LMB阻塞90%以及RMB阻塞50%。我们通过右侧胸部进行了气管下段和部分LMB及RMB的切除手术，并使用了右主支气管瓣作为桥梁，在单独缝合到气管下段和LMB后，完成了隆嵴重建。这一技术对于跨越由于肿瘤广泛侵犯而无法直接吻合的气管与LMB之间的缺陷至关重要。从RMB制作的椭圆形舌形瓣提供了稳定的无张力基础，克服了传统方法的局限性。

结论： 这种新颖的隆嵴重建技术为复杂的气管-隆嵴缺损提供了一种可靠的替代方案，确保了无张力吻合和肿瘤切除的彻底性及其边缘清晰度。