胸骨舌骨肌舌骨瓣转移治疗声门下喉气管狭窄

Treatment of severe subglottic laryngotracheal stenosis using hyoid graft with sternohyoid muscle flap

目的 探讨胸骨舌骨肌蒂舌骨瓣 (hyoidgraftwithsternohyoidmuscleflap ,HG SHMF)转移术治疗复杂声门下喉气管狭窄的可行性。方法 共对 7例因环状软骨和气管软骨环部分缺损或声门下瘢痕组织增生所致的声门下喉气管狭窄患者实施了HG SHMF转移重建术。其中 ,外伤性声门下喉气管狭窄 5例 ,自幼不明原因声门下瘢痕组织增生所致狭窄 1例 ,盐酸气体吸入所致 1例。 7例患者均因气管切开术后不能拔除气管套管而就诊 ,其中 5例已接受 2次以上喉气管探查及重建手术。结果 7例患者术后均顺利拔除气管套管 ,自觉发音质量和呼吸功能较术前明显改善。喉气管扩张子或T型管留置时间平均 9 6个月 ,术后气管套管拔除时间平均 15 4个月。有 2例患者分别因喉气管扩张子和HG SHMF移位需再次行喉气管扩张子置入和HG SHMF复位术 ,该 2例患者分别于术后 6个月和 17个月拔除气管套管 ,恢复了较满意的呼吸和发音功能。结论 HG SHMF转移修复声门下喉气管狭窄的重建手术 ,操作简单易行 ,并发症少 ,具有较高的成功率和较好的远期疗效。术后定期随访可早期发现有无移植物和喉气管扩张子移位以及肉芽组织增生 。

Objective To evaluate the possibility and reliability of the hyoid sternohyoid graft transfer in the correction of server subglottic laryngotracheal stenosis, and delineate the operation skills and clinical results Methods Seven patients with severe subglottic stenosis underwent laryngotracheal reconstruction using the hyoid grafts with sternohyoid muscle flaps (HG SHMF) Five of these patients had traumatic subglottic stenosis, one with scar tissue of unknown etiology arising in the subglottic region, another with tracheal narrowing caused by inhalation of hydrochloric acid Results All seven patients were successfully decannulated with moderate good voice The average time from reconstruction to decannulation was 15 4 months The stent was endoscopically removed with a range of 3 to 22 months; the mean time required for stenting was 9 6 months Two patients who received additional salvage reconstruction procedures because of graft or stent displacement were extubated with improved voices and satisfactory airway Conclusions The HG SHMF transfer was a single stage reconstruction, relatively simple procedure that can restore an adequate airway and a good voice Patients undergoing laryngotracheal reconstruction with HG SHMF must have regular, long term follow up since graft displacement and recurrent granulation tissue or scar reformation can cause restenosis after an initially successful surgery This procedure should be used in a large number of patients to further test its reliability