硬质气管镜下无牵引线Montgomery T型管置入术治疗气管切开后声门下气道闭锁效果观察  

Montgomery T-tube insertion via rigid bronchoscopy with no wire leading for subglottic airway atresia after tracheotomy

作　　者：唐培[1] 司亶 代山 祁亚楠 沈艳丽 陈献亮[1] TANG Pei;SI Dan;DAI Shan;QI Ya-nan;SHEN Yan-li;CHEN Xian-liang(Department of Respiratory Medicine,Henan Provincial People's Hospital,Fuwai Central China Cardiovascular Hospital,Zhengzhou,Henan 450003,China;Department of Anesthesia and Perioperative Medicine,Henan Provincial People's Hospital,Zhengzhou University People's Hospital,Zhengzhou,Henan 450003,China)

机构地区：[1]河南省人民医院阜外华中心血管病医院呼吸内科,河南郑州450003 [2]河南省人民医院郑州大学人民医院麻醉与围术期医学科,河南郑州450003

出　　处：《中华实用诊断与治疗杂志》2023年第4期341-344,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(LHGJ20210126)。

摘　　要：目的探讨硬质气管镜下无牵引线Montgomery T型管(T管)置入术治疗气管切开后声门下气道闭锁的有效性和安全性。方法10例气管切开后声门下气道闭锁患者均行硬质气管镜下无牵引线T管置入术,比较手术前、后mMRC分级、吸氧和正常言语比率,观察术中及术后并发症发生情况;术后随访16~24个月,记录术后拔管时间和成功拔管率。结果10例患者均成功置入T管,术后均恢复声门下气道通畅和经鼻通气。患者术后mMRC分级3~4级(0)、吸氧比率(0)均低于术前(60%、60%)(Z=106.667,P<0.001;χ^(2)=4.167,P=0.041),正常言语比率(80%)高于术前(0)(χ^(2)=6.125,P=0.013)。10例患者术中均未发生气道穿孔、大出血等并发症;术后出现声门水肿6例,颈部皮下气肿1例,T管内严重分泌物潴留2例,T管边缘肉芽组织增生3例,均给予对症处理后好转;均未发生T管移位。术后随访(17.60±2.67)个月,9例成功拔管,拔管时间为(13.89±1.54)个月,拔管成功率为90%。结论硬质气管镜下无牵引线T管置入术治疗气管切开后声门下气道闭锁安全、有效,可恢复声门下气道通畅和经鼻通气,重获发音功能,并发症少。Objective To investigate the effectiveness and safety of Montgomery T-tube(T-tube)insertion via rigid bronchoscopy with no wire leading in the treatment of subglottic airway atresia after tracheotomy.Methods Ten patients with subglottic airway atresia after tracheotomy received T-tube insertion via rigid tracheoscopy with no wire leading.The modified Medical Research Council dyspnea scale(mMRC)grade,and percentages of patients with oxygen therapy required and normal speech were compared before and after surgery.The intraoperative and postoperative complications were observed.The patients were followed up for 16 to 24 months,and the time and success rate of extubation were recorded.Results T-tube was successfully inserted in all patients,and the subglottic airway patency and nasal ventilation were restored after surgery.The percentages of patients with mMRC grade 3-4 and receiving oxygen therapy were lower after surgery(0,0)than those before surgery(60%,60%)(Z=106.667,P<0.001;χ^(2)=4.167,P=0.041),and the percentage of patients with normal speech was higher after surgery(80%)than that before surgery(0)(χ^(2)=6.125,P=0.013).No complications such as airway perforation and massive bleeding occurred.After surgery,there were 6 cases of vocal cord edema,1 case of subcutaneous emphysema of neck,2 cases of serious secretion retention in T-tube,and 3 cases of granulation tissue hyperplasia on T-tube margin,which were relieved after symptomatic treatment.No T-tube displacement occurred.The postoperative follow-up lasted(17.6±2.67)months.Extubation was successful in 9 patients in(13.89±1.54)months,with the successful extubation rate of 90%.Conclusion T-tube insertion via rigid bronchoscopy with no wire leading is safe and effective for subglottic airway atresia,and can restore subglottic airway patency and nasal ventilation with less complications.

关 键 词：声门下气道闭锁 硬质气管镜 Montgomery T型管 

分 类 号：R653[医药卫生—外科学]