气管切除重建术治疗获得性喉气管狭窄  

Laryngotracheal resection and reconstruction for the treatment of acquired laryngotracheal stenosis

作　　者：马丽晶[1] 肖洋[1] 杨庆文[1] 王军[1] 

机构地区：[1]首都医科大学附属北京同仁医院耳鼻咽喉头颈外科,耳鼻咽喉头颈科学教育部重点实验室(首都医科大学),100730

出　　处：《中华耳鼻咽喉头颈外科杂志》2017年第10期738-743,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的分析喉气管切除重建术治疗获得性喉气管狭窄的治疗效果及并发症的预防。方法回顾性分析2007年1月至2016年12月接受喉气管切除重建手术的70例获得性喉气管狭窄患者的临床资料及手术效果，术前采用电子纤维喉镜及螺旋CT对狭窄的位置、范围进行评估，Myer-Cotton分级系统评价狭窄的严重程度。全部病例均采用狭窄段切除及端端吻合术进行喉气管重建，伴或不伴T型硅胶管的置入。结果70例患者中，30例为手术后即拔除气管切开套管，29例手术同时置入T型硅胶管，11例术后保留气管切开套管。狭窄严重程度：Ⅱ级5例，Ⅲ级38例，Ⅳ级27例。狭窄长度5～40 mm，切除长度10～50 mm。手术后半年随访喉功能良好42例，满意23例，失败5例，总体成功率92.9%。术前67例患者已行气管切开，其中62例拔除气管套管，总拔管率为92.5%。术后并发症：5例皮下感染，7例皮下气肿，15例吻合口肉芽形成，9例吻合口裂开。吻合口狭窄9例，其中5例因吻合口大量肉芽造成，4例因吻合口瘢痕挛缩造成，其中2例给予气管内记忆金属支架支撑，1例T型管支撑，1例行二次喉气管切除重建手术，均拔除气管套管；2例仍为T型管置入状态，3例保留气管切开套管。没有发生喉返神经损伤的病例。3例患者同时伴有气管食管瘘，一期修复。结论喉气管切除重建术成功率高，并发症发生率低，是治疗获得性喉气管狭窄安全可靠的治疗方法。ObjectiveTo analyze the efficacy of laryngotracheal resection and reconstruction for acquired laryngotracheal stenosis, and to discuss the prevention of complication.MethodsThe clinical outcomes of seventy patients with acquired laryngotracheal stenosis, treated with laryngotracheal resection and reconstruction were retrospectively reviewed between January 2007 and December 2016. The degree of stenosis was classified according to Myer-Cotton classification as follows： grade Ⅱ（n=7）, grade Ⅲ（n=38） and grade Ⅳ（n=27）. The stenostic extension ranged from 0.5-4.0 cm （median 2.0 cm）, the resection extension ranged from 1.0-5.0 cm （median 3.0 cm）. Fifty-three stenosis originated from iatrogenic （endotracheal tubes and/or tracheostomy）, 17 originated from cervical trauma.ResultsThirty patients were treated by the resection of tracheal and primary anastomosis. Twenty-nine patients were treated by resection and reconstruction and supported by T-tube. Eleven patients with subglottic stenosis were treated by complete resection of tracheal lesion and the arch of cricoid cartilage, together with trachea and thyroid cartilage anastomosis with tracheotomy. Six months after surgery, the outcome was good to satisfactory in 65 patients （92.9%）. Five patients failed（3 were tracheotomized and 2 were supported by T-tube）. Complications included granulation tissue formation（n=15）, anastomoticseparation（n=9）, restenosis of anastomosis（n=9）, wound infection（n=5） and subcutaneous emphysema（n=7）. In 15 patients with granulation tissue, 10 patients needed endoscopic resection, and 5 patients resulted in anastomotic stenosis. No injury to recurrent laryngeal nerve was found. Three patients with trachoesophageal fistula were repaired.ConclusionLaryngotracheal resection and reconstruction is an effective surgical method for acquired laryngotracheal stenosis, which has a higher successful rate and shorter therapeutic period.

关 键 词：气管狭窄 气管切开术 吻合术 外科 手术后并发症 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]