硅酮支架和T管置入治疗复杂声门下良性气管狭窄的疗效比较  

Comparison of the efficacy of silicone stent and T-tube placement in the treatment of benigncomplex subglottic tracheal stenosis

作　　者：王娟[1] 王婷[1] 邱小建[1] 裴迎华[1] 王玉玲[1] 张杰[1] Wang Juan;Wang Ting;Qiu Xiaojian;Pei Yinghua;Wang Yuling;Zhang Jie(Department of Respiratory Medicine,Beijing Tian Tan Hospital,Capital Medical University,Beijing 100050,China)

机构地区：[1]首都医科大学附属北京天坛医院呼吸内科,100050

出　　处：《国际呼吸杂志》2021年第13期1014-1019,共6页International Journal of Respiration

基　　金：北京市自然科学基金(7202042);北京市属医院科研培育计划项目(PX2021022)。

摘　　要：目的复杂声门下良性气管狭窄(狭窄上缘距离声门2 cm以内,狭窄长度≥1 cm并伴有塌陷的良性气道狭窄)的治疗是呼吸介入领域治疗的难题,目前往往需要置入硅酮支架或T管以维持管腔通畅。本研究对两种治疗方法的疗效进行了比较。方法回顾性研究。选取2015年1月至2017年12月首都医科大学附属北京天坛医院呼吸内科收治的复杂声门下良性气管狭窄患者17例:其中硅酮支架组6例,T管组11例。分别记录并比较2组患者声门下狭窄的特点和治疗过程,并对2组疗效进行比较。结果2组患者声门下狭窄的特点(狭窄上缘至声门的距离、狭窄长度、狭窄程度及毗邻正常气管的直径)差异无统计学意义。T管组中T管-正常气管直径比为0.78,硅酮支架组支架-正常气管直径比为0.99。与硅酮支架组比较,T管组的治疗成功率更高(P=0.028),肉芽组织增生率更低(P=0.028),移位率更低(P=0.029)。2组患者治疗过程中均出现痰液潴留、黏膜坏死等并发症,差异均无统计学意义(P值均>0.05)。结论T管的特殊设计使其在使用时可以选择比正常气管直径更小的尺寸,能够减少肉芽组织增生,同时不会造成移位。因此,对于不能手术切除的复杂声门下良性气管狭窄患者,置入T管是维持长期治疗的一个较好选择。Objective Benign complex subglottic tracheal stenosis(benign tracheal stenosis within 2 cm from the glottis,stenosis length≥1 cm with cartilage damage)are difficult to treat and mostly require silicone or T tube implantation.This study compared the efficacy of these two treatment methods.Methods Seventeen patients with benigncomplex subglottic tracheal stenosis,who received silicone stent or T tube implantation at Department of Respiratory Medicine,Beijing Tian Tan Hospital,Capital Medical University between January 2015 and December 2017 were included in the study.Six patients received silicone stent implantation,and 11 received T tube implantation.Demographic data and findings on various aspects of therapeutic procedures were recorded,and the efficacy of both treatment methods compared.Results The two groups did not differ significantly in terms of stenosis distance to glottis,stenosis length,stenosis grade and the mean adjacent normal tracheal diameter.The stent-to-airway diameter ratios in T tube and silicone stent groups were 0.78 and 0.99,respectively.Compared to the silicone stent group,the T tube group had a higher clinical success rate(P=0.028),a lower rate of granulation tissue formation(P=0.028),and a lower rate of migration(P=0.029).Retention of secretions and mucosal necrosis,observed in both groups,did not differ significantly(both P>0.05).Conclusions The unique design of the T tube allows its use in the case of the smaller diameter than that of the trachea,preventing granulation tissue formation and migration.Thus,the tracheal T tube is a viable alternative to long-term management of the unreconstructable trachea.

关 键 词：声门下气管狭窄 硅酮支架 T管 

分 类 号：R562[医药卫生—呼吸系统]