探讨肋软骨瓣移植成形术治疗重症喉气管狭窄成败原因

Rib cartilage graft laryngotracheal reconstruction for severe laryngotracheal stenosis

目的 探讨应用肋软骨移植喉气管成形术治疗重症喉气管狭窄成败原因 ,提高喉气管狭窄成形术技术。方法 回顾分析第四军医大学唐都医院 1983～ 2 0 0 1年采用喉气管裂开移植肋软骨治疗重症喉气管狭窄患者 36例病情及治疗结果 ,研究其成败原因及解决方法。结果 36例中 2 9例 (80 5 % )一次成形术成功治愈 ,拔除气管切开套管 ,恢复正常呼吸 ,经 1～ 10年随访 ,疗效巩固。 7例失败未愈。失败原因 :局部皮肤血循环差 (大剂量放射治疗后 ,反复多次手术局部瘢痕重 ) ,伤口感染软骨坏死排出 ,T形管损伤黏膜形成新的瘢痕狭窄和瘢痕体质。结论 用肋软骨瓣移植术治疗严重或比较严重的喉气管狭窄方法简单 ,带T形管时间短 ,疗效好。缺点是增加一个手术切口 ,游离肋软骨容易发生缺血性坏死 ,颈部皮肤放射治疗后及瘢痕体质者慎用此法。选择好适应证 ,术后加强护理 。

Objective To study the success and failure factors with rib cartilage graft laryngotracheal reconstruction for severe laryngotracheal stenosis for improving the rate of successful decannulation. Methods Thirty-six cases with severe laryngotracheal stenosis, received rib cartilage graft for laryngotracheal reconstruction during the last 18 years in our hospital, were analyzed retrospectively. Results Twenty-nine of the 36 patients (80.5%) were successfully decannulated after one procedure. The follow-up time ranged from 1 to 10 years. All of the 29 patients had a stable airway and normal exercise tolerance. The duration of T-tube stent was 10 days to one year (average 3 months). Seven patients (19.5%) failed to decannulate. The factors of failure were disturbance of local blood circulation, wound infection followed rib necrosis, T-tube injured mucomembrane then became a new stenosis, and restenosis for scar constitution. Conclusion Laryngotracheal reconstraction with rib cartilage graft is one of effective method for severe laryngotracheal stenosis. The procedure is relatively simple, and shorter duration of stenting and higher rate of success. The drawbacks of this technique are ischemia necrosis easily occurred for isolated cartilage and required additional surgery for the donor sit. The patient with scar constitution or undertaken radiotherapy is contraindications. All the managements, appropriate selection of patients, diligent postoperative care, prevented wound infection and using T-tube properly, may increase the rate of successful decannulation.PJP]