成人颈段气管瘢痕性狭窄T形管扩张疗效分析

Efficacy analysis of T type tube dilatation in adult cervical tracheal stenosis

目的:探讨成人颈段气管瘢痕性狭窄应用T形硅胶管扩张术的疗效、复发情况及其对策。方法:回顾性分析2006-06-2016-06期间37例颈段气管瘢痕性狭窄应用T形硅胶管扩张>10个月的患者的临床资料。结果:37例成人颈段气管瘢痕性狭窄中,气管插管或切开所致狭窄29例,外伤6例,多发性软骨炎2例。经一次手术并拔管23例,2次及2次以上手术8例(其中复发病例应用带胸骨舌骨肌蒂舌骨瓣加T形管扩张并拔管3例,气管镜下扩张2例,再次T形管扩张3例),拔管成功率为83.7%。6例长期带管患者中,2例为多发性软骨炎患者,3例为瘢痕体质严重者,1例失访。结论:T形硅胶管扩张治疗成人颈段气管瘢痕狭窄可以取得比较高的拔管率,对于再次狭窄者可考虑多种方法扩张,可提高拔管率;对于拔管后气管内肉芽组织应观察至少1个月后再做处置;对于多发性软骨炎及瘢痕体质较重者,手术方式应谨慎选择。

Objective：To investigate the efficacy,recurrence and strategy of T silicone tube dilatation for cicatricial stenosis of cervical trachea in adults.Method：Cinical data of 37 cases with the cervical tracheal stenosis were retrospectively analyzed,who were firstly treated by T shape silicone tube dilation for at least 10 months,from Jun 2006 to Jun 2016.Result：In 37 adult patients with cicatricial stenosis of the trachea,29 cases were caused by tracheal intubation or incision,6 cases were traumatic,and 2 cases were multiple osteochondritis.Twenty-three cases were experienced one time surgery and extubated successfully,8 cases were experienced 2 times and more than 2 times surgery（sternohyoid muscle flap pedicled hyoid bone with T tube expansion in 3 cases,tracheal endoscopic dilatation in 2 cases,T tube dilatation in 3 cases）,extubation success rate of 83.7%.Among the 6 cases with failure of extubation,2 cases were multiple osteochondritis,3 cases had severe scar constitution,1 cases were lost of follow-up.Conclusion：T type silicon tube expansion for the treatment of adult cervical tracheal stenosis can be achieved relatively high decannulation rate.For recurrent stenosis,we can consider to use various methods of expansion,and improve the decannulation rate.Intratracheal granulation tissuextubation after exbation should be observed for at least 1 month.For concurrent with polychondritis and severe scar the constitution,the operation should be carefully chosen.