甲状软骨翼板移植治疗喉气管狭窄疗效分析

Therapeutic effect of thyroid alar cartilage graft in the treatment of laryngotracheal stenosis

目的探讨自体甲状软骨翼板作移植材料治疗喉气管狭窄的适应症及疗效。方法回顾分析2016年9月~2019年4月在我科用自体甲状软骨翼板行喉气管重建术的患者57例。其中男性39例,女性18例,年龄3~70岁,平均28岁。狭窄部位:声门下25例,气管18例,声门下+气管14例。狭窄程度(Myer-Cotton分度):Ⅱ度24例,Ⅲ度20例,Ⅳ度13例。狭窄长度0.6~3.5 cm,平均1.6 cm。T型硅胶管放置时间4~21个月,平均11.3个月。结果治愈患者50例,治愈率87.7%,其中5例拔除T管后管腔内有肉芽组织,支撑喉镜下咬除肉芽后顺利拔除金属管。7例拔管失败。结论甲状软骨翼板作为加宽气道的移植材料可有效用于治疗喉气管狭窄,对于轻中度狭窄疗效确切,但在重度狭窄中应谨慎使用。

OBJECTIVE To investigate the indications and efficacy of autologous thyroid alar in the treatment of laryngotracheal stenosis.METHODS A retrospective analysis was performed on 57 patients with laryngotracheal stenosis who underwent laryngotracheal reconstruction using autogenous thyroid alar cartilage graft in our department from September 2016 to April 2019.Our study consisted of 39 males and 18 females with a median (range) age of 28 (3-70) years.There were 25 cases developing subglottic stenosis,18 cases developing trachea stenosis,and 14 cases suffering glottis plus trachea stenosis.According to the Myer-Cotton grading system,24 patients had grade II stenosis,20 had grade III,and 13 had grade IV.The stenosis length was 0.6-3.5cm,with an average length of 1.6cm.The placement time of T-tube was 4-21 months,with an average of 11.3 months.RESULTS Fifty cases achieved decannulation.Five patients had granulation tissue in the lumen after T tube was removed,and the metal tracheotomy tube was successfully removed after the granulation was excised under laryngoscope.Seven cases could not be extubated.The cure rate was 87.7%.CONCLUSIONThe thyroid alar cartilage graft is an effective material in laryngotracheal reconstruction.It is effective in treating laryngotracheal stenosis,but it should be used with caution for patients who developed severe stenosis.