Montgomery T管治疗插管或切开后声门下气道狭窄的临床疗效  

Clinical evaluation of Montgomery T-tube in the treatment of subglottic stenosis after tracheal intubation or incision

作　　者：王婷 李伟 宫蓓蕾[1] 沈圆兵[1] 张永艳 武静[1] 许园园[1] 陈余清 WANG Ting;LI Wei;GONG Beilei;SHEN Yuanbing;ZHANG Yongyan;WU Jing;XU Yuanyuan;CHEN Yuqing(Department of Respiratory and Critical Care Medicine,The First Affiliated Hospital of Bengbu Medical College,Bengbu 233004,Anhui,China;Anhui Province Key Laboratory of Clinical and Preclinical Research in Respiratory Disease,Bengbu 233004,Anhui,China;Clinical Research Center for Respiratory Disease(tumor)in Anhui Province,Bengbu 233004,Anhui,China)

机构地区：[1]蚌埠医学院第一附属医院呼吸与危重症医学科,蚌埠233004 [2]呼吸系病临床基础安徽省重点实验室,蚌埠233004 [3]安徽省呼吸系统疾病(肿瘤)临床研究中心,蚌埠233004

出　　处：《医学研究与战创伤救治》2023年第5期468-472,共5页Journal of Medical Research & Combat Trauma Care

基　　金：安徽省重点研究与开发计划项目(202004j07020010);蚌埠医学院第一附属医院新技术项目(2021068)。

摘　　要：目的探讨硬质气管镜下Montgomery T管置入治疗气道插管或切开后声门下气道狭窄的应用价值。方法选取2018年10月至2021年11月蚌埠医学院第一附属医院呼吸内镜室行硬质气管镜下置入T管治疗的13例气道狭窄患者的临床资料。13例患者定期随访,随访时间2018年11月至2022年3月,平均19.37个月,分析近期、远期并发症明确其安全性,基于圣乔治医院呼吸问题调查问卷(SGRQ),嗓音障碍指数量表(VHI-30),进食评估问卷调查工具-10(EAT-10),世界卫生组织生存质量测定量表简表(WHOQOL-BREF),动态评估患者呼吸功能、发音功能、吞咽功能、生存质量的改善情况评价临床疗效。结果所有患者均一次性成功置入T管,术中无并发症。T管置入后患者呼吸困难症状有明显改善,术后SGRQ评分[(24.00±3.11)分]显著低于术前[(36.38±6.88)分],VHI-30评分[(7.07±3.75)分]低于术前[(12.23±7.28)分],EAT-10评分[(20.46±15.24)分]显著低于术前[(32.62±23.34)分],WHOQOL-BREF[(21.54±0.63)分]高于术前[(17.77±2.04)分],差异有统计学意义(P<0.05)。全部患者发音功能、吞咽功能、生存质量明显改善。近期并发症中,声门水肿3例(23.08%),咳嗽咳痰4例(30.77%),没有患者出现感染。远期并发症中主要为分泌物附着管壁8例(61.54%),T管上缘肉芽增生6例(46.15%),T管下缘肉芽增生5例(38.46%)。结论Montgomery T管置入是治疗声门下良性气道狭窄可行、有效的方法,安全性较高,值得临床推荐。Objective To investigate the application value of Montgomery T tube placement under rigid bronchoscope in the treatment of benign subglottic central airway stenosis after tracheal intubation or incision.Methods The clinical data of 13 patients with benign airway stenosis were selected,who were underwent rigid bronchoscopy with T-tube placement in the respiratory endoscopy room of the First Affiliated Hospital of Bengbu Medical College from October 2018 to November 2021.Combined with short-term and long-term complications based on the St.George's Hospital Respiratory Problem Questionnaire(SGRQ),Voice Impairment Index Scale(VHI-30),Eating Assessment Tool-10(EAT-10),World Health The short form of tissue quality of life measurement scale(WHOQOL-BREF)were used to dynamically evaluate the improvement of respiratory function,pronunciation function,swallowing function,quality of life in patients and to ultimately evaluate clinical efficacy.Results All patients were successfully implanted with T tube at one time,and there were no intraoperative complications.The symptoms of dyspnea in patients after T tube placement were significantly improved,and the SGRQ score[(24.0±3.11)points]was significantly lower than that before surgery[(36.38±6.88)points].VHI-30 score[(7.07±3.75)points]was lower than before treatment[(12.23±7.28)points].EAT-10 score[(20.46±15.24)points]was significantly lower than preoperative[(32.62±23.34)points].WHOQOL-BREF[(21.54±0.63)points]was higher than preoperative[(17.77±2.04)points].All patients'(13/13,100%)pronunciation function,swallowing function,and quality of life were significantly improved.Among the recent complications,there were 3 cases of glottis edema(3/13,23.08%),and 4 cases of cough and sputum(4/13,30.77%).Among the long-term complications,6 cases(6/13,46.15%)of the upper branch of the T tube had granulation hyperplasia,5 cases(5/13,38.46%)of the lower branch of the T tube had granulation hyperplasia,and 8 cases(8/13,61.54%)of secretions adhered to the tube wall.Conclusion Montgomer

关 键 词：Montgomery T管 声门下良性气道狭窄 气管镜介入治疗 

分 类 号：R562.1[医药卫生—呼吸系统]