急性喉气管外伤及狭窄的治疗

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]25年来收治急性喉气管外伤38例,喉气管外伤后瘢痕狭窄175例,共213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;17例开放性外伤,进行清创缝合,留置硅胶T型管支撑;13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。175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。175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,168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] 38 patients with acute larygotracheal injuries and 175 patients with larygotracheal stenosis were treat in our hospital during the last 25 years. 17 of 38 patients were open wounds and 21 were blunt injuries, The emergent management of acute injure were assess airway, control of hemorrhage and management of wounds. The rules were the wounds should be treated as early as possible, them mucosal tears sutured, dispaced fragments of cartilag must be replaced finaly in-dwelling Ttube. If there were evidence of cartilaginous dislocated in the blunt injury, open reduction of the injury should be used. [Results] 38 patients were 100% successfully cured, laryngotracheal reconstruction were used in the 175 patients with larygontracheal stenosis. [ Conclusion] The main typies of procedures were paling type laryngotracheal, laryngotracheotomy with grafting, antenorand and postenor cricoid cuts with grafting, conbined myocuysneous flap and rib catilage or hydroxyapatite prosthetic grafting and double T-tube stenting for laryngotracheoesophageal steosis, etc. 168 patients （96%） were successfully decannulted and have a stable airway. The study suggested that a correct managememnd of acute laryngotracheal injuries are best useful for prevente laryngotrachealstenosis. The key of successful treatment of Laryngotracheal stenosisis to choose various methods of reconstruction according to the site and extent of the stenosis.