喉气管狭窄的手术治疗(附44例临床分析)

The Surgical Treatment of Laryngeal and Tracheal Stenosis: A Clinical Analysis of 44 Cases

目的研究喉气管狭窄的手术治疗方法和效果。方法对44例喉气管狭窄的患者进行手术治疗,其中喉狭窄25例,颈段气管狭窄19例,其中外伤引起的7例,经口插管后狭窄8例,气管切开术后狭窄10例,喉癌手术后狭窄17例,甲状腺癌术后声带麻痹1例,甲状腺癌术后气管前壁部分缺损1例。1例行鼻中隔软骨粘膜瓣修复术,1例行支撑喉镜下声门下疤痕切除,2例行喉裂开喉成形术,2例行舌骨肌瓣修复术,38例行T形管置入术。结果术后随访时间6个月~2年,3例T形管取出后憋气,无法拔管,1例T管置入后疤痕形成,再次行喉裂开喉成形术后拔管,其余35例T形管取出后效果良好,顺利拔管,2例喉裂开喉成形术者,其中1例外伤后反复疤痕形成,后行激光切除仍无法拔管,1例恢复好,顺利拔管,其余术式的病人均顺利拔管。结论喉气管狭窄的治疗应根据病因、狭窄的性质、范围、部位制订个体化治疗方案,才可能获得满意的效果,对于较小的喉及声门下气管肉芽,可行支撑喉镜下切除。喉及颈段气管狭窄行疤痕切除后T型管置入术可取得较满意的效果。

Objective To study the surgical treatment method and effect of laryngeal and tracheal stenosis. Methods 44 patients with laryngeal and tracheal stenosis were hospitalized and underwent the operations. Among them there were 25 cases with laryngeal stenosis, 19 cases with cervical tracheal stenosis, and 7 cases were caused by trauma, 8 cases were caused by prolonged tracheal intubation, 10 cases were stenosis after tracheotomy, 17 cases were stenosis after laryngeal carcinoma resection operations, one case was vocal cord paralysis after thyroid surgery and one case was tracheal defection after thyroid surgery. One case underwent nasal septum cartilage repairing, one case underwent subglottic scar resection with retaining laryngoscope, 2 cases underwent laryngofissure and laryngoplasty, 2 cases underwent sternohyoid muscle flap repairing, 38 cases underwent T shaped tube implantation. Results All the patients were followed up for 6 months to 2 years, and 3 patients could not tolerate decannulation after the removal of T shaped tube. One patient suffered a relapse of laryngeal stenosis after the removal of T shaped tube and underwent secondary laryngofissure and laryngoplasty and succeeded in decannulation, the other 35 with T shaped tube got well with their tracheal cannulas removal. Of the 2 patients who underwent laryngofissure and laryngoplasty, one case suffered from repeated scar forming and could not be decannulated after laser surgery and the others were recovered well with their cannulas removal. Conclusions The treatment plan of laryngeal and tracheal stenosis shall be personalized according to the cause, quality, range, position of stenosis to come to a satisfying result. Small laryngeal stenosis can be resected using retaining laryngoscope. T shaped tube can be satisfying in the treatment of laryngeal and cervical tracheal stenosis.