气道支架在声门下狭窄的临床应用与进展  

Clinical application and progress of airway stent in subglottic stenosis

作　　者：邢悦年 李红佳 钟长镐[1] 李时悦[1] Yuenian Xing;Hongjia Li;Changhao Zhong;Shiyue Li(Department of Respiratory and Critical Care Medicine,the First Affiliated Hospital of Guangzhou Medical University,Guangzhou Institute of Respiratory Health,National Clinical Research Center for Respiratory Disease,Guangzhou 510120,China)

机构地区：[1]广州医科大学附属第一医院呼吸与危重症医学科,广州呼吸健康研究院,呼吸疾病国家重点实验室,国家呼吸系统疾病临床研究中心,广州510120

出　　处：《中华结核和呼吸杂志》2022年第11期1140-1146,共7页Chinese Journal of Tuberculosis and Respiratory Diseases

基　　金：广州市科技重点研发计划项目(202103010001)。

摘　　要：喉气管狭窄,是由各种原因造成的喉气管软骨支架畸形、塌陷或缺损,喉气管黏膜瘢痕形成或黏膜下组织增生导致呼吸困难的疾病。声门下狭窄特指声门下至环状软骨下缘的气道狭窄,是喉气管狭窄中的一种特殊类型,最常见病因为医源性损伤,如长时间气管插管及气管切开。现主要治疗方式有外科手术治疗、气管造口术、内镜引导下支架置入以及药物治疗。对于已有呼吸困难且不宜进行手术或者急需术前过渡处理的患者,呼吸内镜引导下的支架置入成为重要的治疗方式。本文对PubMed、CBM、知网、万方、维普等数据库中检索获得的1994年以来有关声门下狭窄支架置入的51篇文献进行回顾,重点比较金属支架、沙漏形、直筒形DUMON支架及Montgomery T形管的疗效,并发症及预后,探讨内镜引导下支架置入在声门下狭窄的临床应用。文献研究表明,相较于DUMON硅酮支架和金属支架,T形管有着更显著的优势、更高的治疗成功率以及更低的并发症率。因此认为Montgomery T形管更适用于声门下狭窄患者的长期治疗。随着人类科技的不断进步,新工艺新材质的不断完善和更新,新型气道支架的蓬勃发展也为声门下狭窄患者提供了全新的组织相容性更好、并发症更少、可个体化定制的支架治疗模式。Laryngotracheal stenosis is caused by various reasons of laryngotracheal cartilage stent malformation,collapse or defect,laryngotracheal mucosa scar formation or submucosal tissue hyperplasia,eventually resulting in dyspnea.Subglottic stenosis refers to the airway stenosis from subglottic to the lower margin of the cricoid cartilage,which is a special type of laryngotracheal stenosis.The most common cause is iatrogenic injury,such as prolonged tracheal intubation and tracheotomy.Currently,the main treatments include surgical treatment,tracheostomy,endoscope-guided stent implantation and drug therapy.As for the patients who have dyspnea not suitable for surgery or in urgent need of preoperative transitional treatment,stent implantation guided by respiratory endoscopy has become an important treatment.In this paper,we reviewed 51 literatures on stent implantation of subglottic stenosis since 1994 retrieved from PubMed,CBM,CNIT,Wan-fang and VIP databases,focusing on the comparison of the efficacy,complications and prognosis of metal stent,hourglass-shaped DUMON stent,straight-type DUMON stent and Montgomery T tube and investigated the clinical application of endoscope-guided stent implantation in subglottic airway stenosis.Literature studies have shown that compared with DUMON silicone stents and metal stents,T tube has more significant advantages,higher treatment success rate and lower complication rate.Therefore,Montgomery T tube is more suitable for long-term treatment of patients with subglottic stenosis.With the improvement and update of new technology and materials,the vigorous development of new airway stents also provides a new stent treatment mode with better histocompatibility,fewer complications and customized options for the patients with subglottic stenosis.

关 键 词：声门下狭窄 医源性损伤 气管切开 气管造口术 组织增生 金属支架 喉气管 呼吸困难 

分 类 号：R653[医药卫生—外科学]