摘要
目的:探讨喉气管狭窄手术方案的选择及其效果分析。方法:回顾性分析了2015年10月至2021年12月在南京同仁医院耳鼻咽喉头颈外科接受手术治疗的获得性喉气管狭窄32例患者资料,其中男性21例,女性11例,年龄19~72(34.0±9.0)岁;病史1~32个月(中位时间3个月)。病因:医源性喉气管狭窄30例,其中气管插管导致20例,气管切开 10 例(经皮气管切开7例,传统气管切开3例);喉气管外伤1例,呼吸道马尔尼菲青霉菌感染1例。Myer-Cotton分度Ⅳ度狭窄14例,其中累及气管12例,同时累及气管及声门下区2例;Ⅲ度18例,均为累及颈段气管者。外院手术失败5例。根据患者不同的狭窄程度、病程、原发病控制情况及全身一般状况个体化确定手术方案,分别采用气管袖状切除端端吻合、环气管部分切除、CO 2激光气管肉芽(或瘢痕)切除及T型管置入手术。观察术后1年气道功能恢复及围手术期并发症情况。 结果:袖状切除端端吻合16例,环气管部分切除2例,CO 2激光气管肉芽(瘢痕)切除2例,T型管置入12例患者。其中袖状切除端端吻合、环气管部分切除及CO 2激光气管瘢痕切除患者均一期恢复气道功能,1年后治愈19例,有效1例;T管置入患者6~12个月后成功拔管9例(疗效判定为治愈7例,有效2例),另3例患者拔除T管后,再次发生狭窄,其中2例二期行袖状切除端端吻合成功实现拔管,随访1年疗效均判定为治愈。而另1例拒绝接受其他治疗方式,再次置入T管,堵管健康生存。患者随访期内总治愈率87.5%(28/32),有效率9.4%(3/32),无效率3.1%(1/32),总拔管率96.9%。术后最常见并发症为皮下气肿,占78%(25/32),但无严重纵隔气肿及气胸发生;T型管置入组术后颈部创口周围均有不同程度肉芽组织生长,6~9个月后好转或消失;T型管置入组拔管后4例发生颈前气管瘘,行造瘘口封闭手术治愈。患者均无严重出血、围手术期死亡等并发症。 结论:存在多种因素影响时,基于喉气管狭窄程度、病程、原发病控制情况及全身状况确定手术方案,是提高喉气管狭窄疗效的重要保障。
ObjectiveTo explore the optimization of surgical procedures for laryngotracheal stenosis and its effect analysis.MethodsThe data of 32 patients with acquired laryngotracheal stenosis who received surgical treatment from October 2015 to December 2021 were analyzed retrospectively.The age ranged from 19 to 72 years,with an average of(34.0±9.0)years.The medical history ranged from 1 to 32 months(median 3 months).As for etiology,there were 30 cases of iatrogenic laryngotracheal stenosis,including 20 cases of tracheal intubation and 10 cases of tracheotomy(7 cases of percutaneous tracheotomy and 3 cases of traditional tracheotomy).There were 1 case of laryngotracheal trauma and 1 case of airway Penicillium marneffei infection.According to Myer-Cotton grading system,gradeⅣstenosis was found in 14 cases,including 12 cases involving trachea and 2 cases involving trachea and subglottic area.There were 18 cases of gradeⅢ,all of which involved the cervical trachea 5 cases failed in operation in other hospitals.According to stenosis grading,course of disease,primary disease control and the patient′s general condition,the surgical plan was determined individually.The operations of end-to-end anastomosis,circumferential tracheal partial resection,T-tube placement and CO_(2) laser tracheal scar resection were performed respectively.The recovery of airway function and perioperative complications were observed one year after operation.ResultsEnd-to-end anastomosis was performed in 16 cases,and partial circumferential tracheal resection in 2 cases,and tracheal granulation(scar)resection by CO 2 laser in 2 cases and T-tube insertion in 12 cases.Eighteen cases which performed end-to-end anastomosis,partial resection of circumferential trachea in and 2 cases which performed laser tracheal scar resection were all recovered airway function at one stage.After 1 year,19 cases were cured and 1 case was effective.Of 12 patients with T tube implantation,11 cases were successfully extubated after 6-12 months,7 cases were cured after 1 year,2 cases were effective and 3 cases were ineffective.Among the 3 cases of failure,2 cases were successfully extubated by sleeve resection and end-to-end anastomosis in the second stage,and the other case refused to accept other treatment methods and the T-tube was placed again,and the tube was blocked and the patient survived.During the follow-up period,the total cure rate was 87.5%,the effective rate was 9.4%,and the total extubation rate was 96.9%.The most common complication was subcutaneous emphysema,accounting for 78%(25/32),but no serious mediastinal emphysema or pneumothorax occurred.In the T-tube implantation group,granulation tissue grew in different degrees around the neck wound after operation,and improved or disappeared after 6-9 months.Anterior cervical tracheal fistula occurred in 4 cases of T-tube implantation group after extubation,which were cured by sealing the stoma.There were no complications such as severe bleeding or perioperative death.ConclusionWhen there were various factors,the optimization of the surgical plan according to the degree of stenosis,the course of disease,the control of primary disease and the general condition was an important guarantee to improve the curative effect of laryngotracheal stenosis.
作者
刘亚群
张庆翔
何双八
孟洁
蔡明静
黄栋栋
Liu Yaqun;Zhang Qingxiang;He Shuangba;Meng Jie;Cai Mingjing;Huang Dongdong(Department of Otorhinolaryngology Head and Neck Surgery,Nanjing Tongren Hospital,Nanjing 211102,China)
出处
《中华耳鼻咽喉头颈外科杂志》
CSCD
北大核心
2024年第1期34-37,共4页
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
关键词
气管狭窄
喉狭窄
气道重建
个体化外科手术
Tracheal stenosis
Laryngostenosis
Airway reconstruction
Individualized surgical procedures
作者简介
通信作者:张庆翔,Email:zhangqx@njtrh.org。
