环气管部分切除术及其扩大术式治疗严重喉气管狭窄效果分析

Effect of partial cricotracheal resection and extended cricotracheal resection for severe laryngotracheal stenosis

目的分析环气管部分切除术及其扩大术式治疗严重喉气管狭窄的效果。方法回顾性分析2009年11月至2017年9月在空军军医大学唐都医院耳鼻咽喉头颈外科行环气管部分切除术治疗的喉气管狭窄患者18例,其中男12例,女6例,年龄4~56岁,中位年龄25岁。病因:气管插管呼吸机治疗后引起11例,颈部外伤4例,特发性3例。狭窄部位:声门下+气管12例,声门+声门下+气管3例,声门下2例,声门+声门下1例,伴一侧声带固定者2例。1例术前曾行球囊扩张,8例曾行喉气管重建术。喉气管狭窄严重程度按欧洲喉科学会提出的改良Myer-Cotton方法分度:Ⅲb 1例,Ⅲc 1例,Ⅳa 2例,Ⅳb 12例,Ⅳc 2例。观察记录手术效果、拔管情况及并发症发生情况。结果18例患者中,采用环气管部分切除术12例,拔管11例;扩大的环气管部分切除术6例,拔管5例。切除狭窄段气道长度1.5~4.0 cm,中位数2.8 cm。术后并发症:伤口感染2例,吻合口肉芽2例,皮下气肿1例,误吸1例,一侧杓状软骨脱垂1例。无喉返神经损伤和气管食管瘘发生。中位随访时间11个月。结论环气管部分切除术是治疗严重声门下狭窄并累及上段气管狭窄的有效治疗方法,其扩大术式对累及声门的狭窄也有效。这两种术式也为喉气管重建术失败的患者提供了挽救性的治疗方法。

Objective To assess the outcomes of partial cricotracheal resection(CTR)and extended cricotracheal resection(ECTR)for severe laryngotracheal stenosis.Methods From November 2009 to September 2017,18 patients underwent CTR and ECTR at the Department of Otorhinolaryngology Head and Neck Surgery,Tangdu Hospital,Air Force Medical University for severe laryngotracheal stenosis were reviewed retrospectively.There were 12-male and 6-female patients,with the age ranged from 4 to 56 years(median 25 years).The causes were postintubation in 11 cases,cervical trauma in 4,idiopathic in 3.The stenosis located in subglottic and tracheal(n=12),glottic and subglottic and tracheal(n=3),subglottic(n=2),and glottic and subglottic(n=1).Two patients had concurrent unilateral vocal cord palsy.One patient had undergone previous endoscopic balloon dilation and 8 patients had previous laryngotracheal reconstruction.The stenosis was graded according to modified Myer-Cotton classification as follows:Ⅲb(n=1),Ⅲc(n=1),Ⅳa(n=2),Ⅳb(n=12),Ⅳc(n=2).The surgical outcomes and complications were recorded.Results Among 18 patients,11 of the 12 patients undergoing CTR were decannulated.Five of the 6 patients undergoing ECTR were decannulated.Resected airway length ranged from 1.5 to 4.0 cm(median 2.8 cm).Surgical complications included infection of incision wound in 2 cases,anastomotic granulation in 2,cervical subcutaneous emphysema in 1,aspiration in 1,and unilateral arytenoid prolapse in 1.No recurrent laryngeal nerve injury or tracheoesophageal fistula occurred.The median follow up was 11 months.Conclusions CTR is efficient for severe subglottic and upper tracheal stenosis while ECTR is efficient for subglottic stenosis extended to the glottis.Both procedures also provide a salvage therapy for patients with previous failed treatments.