不同术式治疗喉气管狭窄的疗效观察

The Clicinal Effect of Different Surgical Treatment for Laryngotracheal Stenosis

目的总结不同手术方法治疗喉气管狭窄的临床疗效。方法回顾性分析2006年7月～2014年7月手术治疗的56例喉气管狭窄患者（儿童7例,成人49例）的临床资料,其中9例行支撑喉镜下CO_2激光瘢痕切除术,5例行支撑喉镜下低温等离子射频瘢痕组织消融术,5例行支撑喉镜下硅胶片或导尿管喉模置入术,6例行喉裂开聚丙烯支架置入术,23例行喉气管成型加T管植入术,8例行气管环形切除端端吻合术,术后随访6个月～2年,观察不同手术方式患者的治疗效果。结果单次手术治愈39例,多次手术治愈10例,复查无再次气道狭窄;无效5例,长期带管生存;失访2例,无死亡及并发症发生的病例。其中,5例喉模置入患者和8例气管端端吻合患者均一次手术治愈;9例行CO2激光瘢痕切除术的患者中1次手术治愈5例,2次手术治愈3例,1例喉癌复发;5例低温等离子射频消融术治疗患者中3例一次手术治愈,1例2次手术治愈,1例无效;6例聚丙烯支架置入的患者中1次手术治愈4例,2次手术治愈1例,1例无效;23例T管置入术的患者中1次手术治愈14例,2次及2次以上手术治愈5例,2例无效,2例失访。结论治疗喉气管狭窄需要依据狭窄程度、狭窄部位及喉气管支架缺损情况等采取个体化治疗方法,才能取得满意效果。

Objective To study the clinical effects of different surgical treatments for laryngotracheal stenosis. Methods The clinical data of 56 patients with laryngotracheal stenosis from July 2006 to July 2014 were ana- lyzed. Of all 56 cases,7 cases were children, 49 cases were aducts; 9 cases underwent CO2 laser resection, 5 cases underwent temperature controlled radiofrequency ablation and 5 cases received laryngeal mold under self--retaining laryngoscope,6 cases received Keel placement after laryngofissure,23 cases received T-- shape tube implantation af- ter laryngoplasty or tracheoplasty and 8 cases underwent end--to--end tracheal anastomosis after cervical tracheotomy. Results All the patients had been followed up for 6 months to 2 years postoperatively. Thirty nine cases of 56 were cured after single--operation, and 10 of 56 were cured after repeated operations. No one suffered from laryn- gotracheal stenosis again. Five cases failed and survived with tracheal tube. 2 cases lost to follow--up. No people die or had complications. Among all cases, 5 cases with laryngeal mold and 8 cases with tracheal anastomosis were cured after single--operation. Among 9 cases with lasere scar removal surgery, 5 cases were cured after an operation, 3 cases were cured after two operations, 1 case failed because of laryngeal cancer recurrence. Among 5 case with tem- perature controlled radiofrequency ablation, 3 cases were cured afrter an operation, 1 case was cured after two opera- tions, 1 case had no effect. Among 6 cases with keel place--ment, 4 cases were cured after one operation, 1 case was cured after two operations, 1 case had no effect. Among 23 cases with T--shape tube implantation, 14 cases were cured after an operstion, 5 cases were cured after two and more operations, 2 cases had no effects and 2 cases were lost. Conclusion In order to improve the therapeutic effects of laryngotracheal stenosis,the treatment strategy should be personalized according to the degree of stenosis , the position of stemtis, and the impairment of laryngotra- cheal framework.