Montgomery-T型管置入术治疗复杂声门下良性气管狭窄29例临床分析  

Efficacy and safety of Montgomery T-tube placement for benign complex subglottic tracheal stenosis:a retrospective analysis of 29 cases

作　　者：金贝贝[1] 王娟[1] 王玉玲[1] 邱小建[1] 裴迎华[1] 王婷[1] 张杰[1] Jin Beibei;Wang Juan;Wang Yuling;Qiu Xiaojian;Pei Yinghua;Wang Ting;Zhang Jie(Department of Pulmonary and Critical Care Medicine,Beijing Tiantan Hospital,Capital Medical University,Beijing 100070,China)

机构地区：[1]首都医科大学附属北京天坛医院呼吸与危重症医学科,100070

出　　处：《中华结核和呼吸杂志》2021年第12期1064-1070,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：北京市临床重点专科项目(京卫医[2020]129)。

摘　　要：目的分析Montgomery-T型管(简称T管)置入术治疗复杂声门下良性气管狭窄的有效性及安全性。方法回顾性分析北京天坛医院2015年5月至2019年12月接受T管置入术治疗的29例复杂声门下良性气管狭窄患者的临床资料,病因分别为气管置管后气管狭窄[27例(93.1%),其中气管切开后气管狭窄21例(72.4%),气管插管后气管狭窄6例(20.7%)],颈部外伤后气管狭窄(1例,3.4%),结核后气管狭窄(1例,3.4%)。术前采用气管CT三维重建及气管镜对狭窄程度进行Cotton-Myer分级,其中Cotton-MyerⅡ级7例(24.1%),Ⅲ级11例(37.9%),Ⅳ级11例(37.9%)。全部病例置入T管并持续随访。组间比较采用Fisher精确检验。结果29例患者共进行T管置入术39次。共成功放置T管24例(82.8%)。术中主要并发症为气管黏膜撕裂(6例,20.7%),均在2周内愈合。术后主要并发症为分泌物潴留(27例,93.1%),其中26例经家庭雾化治疗后T管内分泌物潴留不影响正常通气;T管上缘肉芽增生(12例,41.4%),其中8例经气管镜下介入处理后肉芽消失。无T管移位病例。不同狭窄程度的复杂声门下气管狭窄患者T管置入成功率及主要并发症发生率差异均无统计学意义。随访18~24个月后,9例患者尝试取出T管,4例失败,失败原因均为T管取出后气道塌陷。结论T管置入术治疗复杂声门下良性气管狭窄有效率高,并发症可治可控,是安全可靠的治疗方法。Objective To analyze the efficacy and safety of Montgomery T-tube(T-tube)placement for benign complex subglottic tracheal stenosis.Methods A retrospective analysis of the clinical data of 29 patients with benign complex subglottic tracheal stenosis receiving T-tube placement in Beijing Tiantan Hospital from May 2015 to December 2019.The causes were postintubation tracheal stenosis[27 cases(93.1%),including 21 cases(72.4%)of tracheal stenosis after tracheotomy,6 cases(20.7%)of tracheal stenosis after tracheal intubation],cervical post-traumatic tracheal stenosis(1 case,3.4%)and tuberculous tracheal stenosis(1 case,3.4%),respectively.Three-dimensional reconstruction of tracheal computerized tomography(CT)and bronchoscopy were used to grade the stenosis according to Cotton-Myer classification system before bronchoscopic intervention.The degree of stenosis was Cotton-Myer gradeⅡ(7 cases,24.1%),gradeⅢ(11 cases,37.9%)and gradeⅣ(11 cases,37.9%),respectively.All cases received placement of T-tubes and follow-up.Fisher′s exact test was used for comparison between groups.Results T-tube placement was performed 39 times in 29 patients.T-tubes were successfully placed for 24 cases(82.8%).The main complication during the operation was tracheal mucosal tear(6 cases,20.7%),which resolved in all cases within 2 weeks.The main postoperative complication was secretion retention(27 cases,93.1%),which was relieved after home nebulization treatment in 26 cases;and followed by granulation hyperplasia,especially located in T-tube upper margin(12 cases,41.4%),of which 8 cases were cured after bronchoscopic intervention.None of the patients had T-tube migration.There were no statistically significant differences in the success rate of T-tube placement and the incidence of major complications in patients with benign complex subglottic tracheal stenosis with different degrees of stenosis.After 18 months to 24 months of follow-up,attempt was made to remove the T-tube in 9 patients but failed in 4 patients.The failure was due to collap

关 键 词：气管狭窄 Montgomery-T型管 声门下 

分 类 号：R653[医药卫生—外科学]