喉气管狭窄重建术20年经验

Reconstruction of laryngotracheal stenosis:experience of twenty years

为了提高喉气管狭窄的重建技术。总结２０年来２６１例喉气管狭窄的治疗。８８．８％患者术前都依靠气管切开套管呼吸。主要手术方法：声门重建术；栅栏状喉气管重建术；喉气管切开加自体或人工合成移植物重建术等。结果：２６１例中，９例未愈，５例失访；２４７例（９４．６％）已拔管治愈。１９２例随访１～１８年，４例３年后再狭窄，其中３例再手术治愈。１０例未愈，１８２例（９４．７％）疗效巩固。结论：喉气管狭窄的治疗应根据病情选择手术方法和移植物；栅栏状喉气管重建术具有方法简单，抗感染力强优点；严重喉气管狭窄、闭锁或合并气管大面积缺损以双蒂肌皮瓣、复合肋软骨和人工气管环重建术效果较好；支撑器的应用在喉气管重建中有重要作用。

In order to improve the curative effects of laryngotracheal stenosis, 261 patients treated for laryngotracheal stenosis during the last twenty years were retrospectively reviewed. Glottic reconstruction, fence form laryngotracheal reconstruction and laryngotracheotomy with autogenous tissue or hydroxylapatite rings were selectively used for one stage reconstruction. Our results demonstrated that among 261 patiens, 9 failed in decannulation, 5 were lost for follow up, 247 (94.6%) patients were successfully decannulated. Among 192 patients followed up from 1 to 18 years, 4 had restenosis 3 years after operation, 3 were successfully retreated and 10 failed. 182 (94.7%) patients had stable airways. It is concluded that there was no fixed treatment for laryngotracheal stenosis. The choice of surgical procedure and grafting must be decided on the pathologic condition of the larynx and trachea. The advantages of fence form laryngotracheal reconstruction are simple technique and good result. Reconstruction with combined bipedicled myocutaneous flap and costal cartilage or artificial materials are better for severe laryngotracheal stenosis and large tracheal defect. The usage of stent is important for laryngotracheal reconstraction.