自制喉扩张模在预防外伤性喉气管狭窄中的应用

Self-invented laryngeal stent in prevention of laryngotracheal stenosis after trauma

目的研究自制喉扩张模在预防严重喉气管损伤术后喉气管狭窄的疗效,探讨放置喉扩张模的时限。方法1992年1月～2004年12月收治严重喉气管损伤患者26例,其中闭合性损伤7例,开放性损伤19例,全部行气管切开、创伤探查及喉气管成形术。根据喉气管管腔大小和形状,用医用热凝塑料制成喉模,放置于喉腔。喉扩张模的膨大部分超过狭窄部位5mm以上,上端不超过杓状软骨平面,峡部位于声门裂处,用粗丝线上端从鼻腔引出,固定于面颊部;下端由气管切开口引出到颈外,固定于气管套管底座上,关闭喉腔,颏胸固定。结果26例患者均于术后2～3个月顺利拔除喉模和气管套管,带喉扩张模期间无严重并发症。24例患者伤口一期愈合;2例伤口感染,二期愈合。术后随访1年以上,除1例出现声门下狭窄外,其余25例气管通畅,发声满足日常交流,均未出现喉气管狭窄。结论使用医用热凝塑料制作喉扩张模放置2～3个月,可有效预防外伤性喉气管狭窄;且制作简单,可实现个体化,组织相容性好,费用低廉。

Objective To investigate the effect of self-invented laryngeal stent on preventing laryngotracheal stenosis after trauma and the optimal stay time for application . Methods The clinical data of 26 patients with laryngtracheal trauma was analyzed. There were 7 patients with close laryngotracheal trauma and 19 with open laryngotracheal trauma. An the patients underwent tracheotomy and laryngotracheal reconstruction using self-invented personalized stents made with medical thermosetting plastics. Results In all the 26 patients, the stents and tracheal tubes were successfully removed 2 -3 months after operation. 25 patients （96. 15 % , 25/26 ） achieved near normal respiratory and phonatory functions withno stenosis after more than 1 years followup. Only 1 patient developed subglottic stenosis. Conclusion Laryngeal stent made from medical thermosetting plastics can effectively prevent laryngotrachal stenosis caused by trauma effectively. The optimal stay of the stent was 2 - 3 months.