医源性喉气管狭窄的临床研究

Treatment and prevention of iatrogenic laryngeal and tracheal stenosis

目的 回顾性分析近 2 0年在本科住院治疗的医源性喉气管狭窄患者 88例 ,探讨医源性喉气管狭窄的病因、治疗和预防措施。方法 根据喉气管狭窄的范围和程度 ,应用激光切除、喉气管裂开 ,去除瘢痕并利用颈前肌皮瓣、肋软骨、舌骨肌瓣等加宽狭窄部位 ,术腔放入T型硅胶管支撑。结果 本组 83例患者拔管治愈 ,除声嘶外均恢复了正常的吞咽和呼吸功能 ,手术成功率 94 %。结论 医源性喉气管狭窄病情复杂、多变 ,治疗困难 ,因而选择适当的治疗方法和有效的预防措施同等重要。本文提醒医务工作者在进行麻醉插管、气管切开、处理喉气管外伤等手术操作时掌握正确的方法 。

Objective To improve the tecnique of the treatment and prevention of iatrogenic laryngotracheal stenosis. Methods According to the pathologic condition of the larynx and trachea,various surgical procedures were designed for the treatment of laryngotracheal stenosis. These techniques included laser therapy and laryngotracheoplasty with autogenous tissue graft and stent. Results Among 88 patients,83 cases were decannulated. The treatment was successful in 94% of the cases. Couclusion The pathologic condition of iatrogenic laryngotracheal stenosis is very complex and variable. Most of the patients are children and treatment are more difficult. It is very important to prevent and choose adequate treatment.