急性喉气管外伤及狭窄213例治疗体会

Treatment of acute laryngotracheal injuries and laryngotracheal stenosis

目的 研究急性喉气管外伤不同类型及喉气管狭窄在临床中的各种治疗方法。方法 2 5年来收治急性喉气管外伤 38例 ,喉气管外伤后瘢痕狭窄 1 75例 ,共 2 1 3例。 38例急性喉气管外伤中 ,8例闭合性喉腔软组织伤或合并软骨骨折而无移位 ,采用药物保守治疗 ;1 7例开放性外伤 ,进行清创缝合 ,留置硅胶T型管支撑 ;1 3例闭合性伤 ,喉气管软骨损伤 ,行开放手术复位骨折 ,硅胶T形管支撑治疗。 1 75例喉气管瘢痕狭窄者采用栅栏状喉气管成形术 ;喉气管裂开肋软骨移植术 ;胸舌骨肌瓣移植术 ;复合软骨肌皮瓣成形术 ;摇门式胸舌骨肌皮瓣成形术与复合人工骨肌皮瓣成形术等方法治疗。结果 38例急性喉外伤全部痊愈无后遗症。 1 75例喉气管瘢痕狭窄者 ,4例尚带硅橡胶T型管治疗中 ,3例未治愈 ,1 6 8例治愈 ,拔除气管套管恢复正常呼吸 ,治愈率 96 %。结论 急性喉气管外伤尽早明确诊断 ,早期治疗。喉气管外伤后瘢痕狭窄患者 ,根据狭窄部位和程度采用栅栏状喉气管成形术 ,喉气管裂开自体组织或复合人工骨肌瓣等移植物喉气管成形术 ,效果十分理想。

Objective To study the treatment of acute laryngotracheal injuries and laryngotracheal stenosis.Methods A total of 213 patients with acute laryngotracheal injuries (n=38) and laryngotracheal stenosis (n=175) were admitted in this hospital in the past 25 years.The acute injuries included 17 open wounds and 21 closed injuries. The emergency management of acute injury consisted of assessment of airway,control of hemorrhage,and management of wounds. The wounds should be treated as early as possible,mucosal tears be sutured, displaced fragments of cartilage be replaced and supported with an in-dwelling silicone T-tube. If there was evidence of cartilage dislocation in the blunt injury, open reduction of the injured part should be performed.Laryngotracheal reconstruction were carried out in the 175 patients with laryngotracheal stenosis.The main procedures included paling-type laryngotracheoplasty,laryngotracheotomy with grafting,anterior and posterior cricoid cuts with grafting,combined myocutaneous flap and rib cartilage or hydroxyapatite prosthesis grafting,and double T-tube stenting for laryngotracheal stenosis.Results All the 38 patients with acute laryngotracheal injury were successfully cured without sequelae.Of the 175 patients with laryngotracheal stenosis,168(96%) were successfully decannulated and have a stable airway.Conclusions Correct managememnt of acute laryngotracheal injuries is highly important for preventing laryngotracheal stenosis. The key to successful treatment of laryngotracheal stenosis is to choose appropriate method of reconstruction according to the site and extent of the stenosis.