喉气管狭窄闭锁缺损的手术治疗

目的　为提高喉气管狭窄、闭锁或缺损患者的治疗效果,总结了４５ 例不同部位和范围的狭窄、闭锁或缺损患者的重建原则和手术方法。方法　根据病变部位和范围不同,分别采用不同的整复方法如单纯瘢痕切除扩张、粘膜对位缝合、“Ｚ”形减张缝合、粘膜瓣、皮瓣、肌筋膜、肌蒂锁骨膜等整复方法和气管对端缝合以及沟槽法等。结果　除１ 例失访和１ 例呼吸稍差外,４３ 例均取得了满意的呼吸及发音效果（３７ 例发音嘶哑）。结论　喉气管狭窄、闭锁或缺损的治疗,应根据病变部位和范围的不同而采取不同的处理原则和手术方法。     

喉气管狭窄的手术治疗

目的 :提高喉气管狭窄的手术疗效。方法 :对 70例不同狭窄部位和范围的患者 ,根据病变具体情况 ,分别采用不同的手术整复方法。结果 :65例治愈 ,治愈率为 92 .9% ;术后扩张子放置时间平均为 14 .8d ,拔管时间平均为 82 .0d。结论 :喉气管狭窄的治疗应根据不同的病变部位和范围采取不同的处理原则和手术方法 ;重建喉气管支架和消除创面是提高疗效的关键     

喉气管狭窄的手术治疗

目的:探讨瘢痕性喉气管狭窄的手术疗效。方法:对14例喉气管狭窄患者分别采用声门上水平切除术、鼻中隔软骨瓣移植术、双蒂胸前骨肌转门肌瓣及肋软骨瓣移植术修复喉气管狭窄。结果:10例经一次手术治愈,3例经二次手术治愈,1例失败。结论:喉气管狭窄应根据狭窄部位、程度选择合适的移植材料和成形术,可提高手术成功率。     

喉气管狭窄的手术治疗

目的 探讨喉气管狭窄的手术方法及疗效。 方法 回顾分析山东省千佛山医院耳鼻咽喉头颈外科2009至2015年16例喉气管狭窄手术的临床资料,其中3例喉气管钝性挫伤、1例喉乳头状瘤术后反复狭窄、1例喉癌术后肉芽生成分别实施支撑喉镜下CO₂激光切除术。1例喉癌术后气管内鳞癌、多形性腺瘤及气管腺样囊性癌在鼻内镜下行切除术。1例长时间气管内插管致气管狭窄及1例气管囊腺癌者行气管袖状切除断端吻合术。1例气管腺样囊性癌、2例甲状腺癌及1例气管外伤后狭窄行喉气管重建术。1例食管癌晚期致喉狭窄及1例喉气管外伤老年患者行镍钛记忆合金支架植入术。 结果 随访12~24个月,除2例外,其余患者均手术后拔管。其中1例喉气管重建术放置T形管后肉芽再次生长;另1例镍钛记忆合金支架植入术后出现排异反应,取出支架,此2例均无法拔管,自动出院后失访。 结论 喉气管狭窄的手术治疗应根据狭窄的位置及程度选择不同的手术方法,可获得良好的效果。     

儿童喉气管狭窄的治疗

分析１９年来４２例儿童后天性喉气管狭窄，年龄自１５个月到１４岁，平均８岁。主要病因有气管切开术后；喉气管外伤；复发性喉乳头状瘤术后；气管内插管等。全部病例狭窄严重，依靠气管切开呼吸。采用不同的喉气管重建术。结果４０例病人经１￣１８年随访，３６例（９０．０％）拔除气管套管，治愈。结论：①提高气管切开术技术，可以减少儿童喉气管狭窄发病率；②３岁以上儿童可以进行喉气管重建术；③手术方式的选择必须根据喉气     

喉气管狭窄的支撑内固定疗效观察

对１２例喉气管狭窄病人行支撑固定治疗,手术时首先切除喉气管病变,松解瘢痕组织,局部修复后行扩张治疗,方法为：①用空心管做喉气管内固定扩张;②硅橡胶囊喉模软固定支撑;③“Ｔ”形管置入支撑。支撑扩张时间２周～１８个月。结果：９例顺利拔管;１例带管放疗１年后拔管;１例拔管后肿瘤复发改行半喉切除术;１例未支撑,带管随访中,认为喉气管狭窄行支撑内固定疗法,效果较满意。     

喉气管狭窄治疗方法的选择

目的：探讨喉气管狭窄的治疗方法。方法：根据喉气管狭窄的范围和程度,选用气管镜扩张、激光切除、喉气管切开成形和支撑器置入扩张等方式,对３６例后天性喉气管狭窄患者进行治疗。结果：３２例患者拔管治愈,成功率为８８．８％。结论：喉气管狭窄病情复杂多变,术中应根据病变的范围和程度,选择适当的治疗方法,方能获得满意的效果。     

喉气管狭窄的预防和治疗进展

喉气管狭窄是临床治疗上的难题,导致狭窄的原因有多种,治疗方法多样,但是尚无特效的手段,处理非常棘手。医源性狭窄病情复杂,积极预防喉气管狭窄的发生尤其重要。本文就喉气管狭窄的原因、预防和治疗进展进行综述。     

喉气管狭窄重建术20年经验

为了提高喉气管狭窄的重建技术。总结２０年来２６１例喉气管狭窄的治疗，８８．８％患者术前都依靠气管切开套管呼吸。主要手术方法：声门重建术、栅栏状喉气管重建术，喉气管切开加自体或人工合成移植重建术等。结果：２６１例，９例未愈，５例失访，２４７例（９４．６％）已拔管治愈。１９２例随访１￣１８年，４例３年后再狭窄，其中３例再手术治愈。１０例未愈，１８２例（９４．７％）疗效巩固。结论：喉气管狭窄的治疗应根据     

喉气管狭窄的手术治疗分析

目的探讨喉气管狭窄的手术治疗方式和疗效。方法对25例喉气管狭窄的患者进行手术治疗,其中4例喉癌术后肉芽增生,1例喉乳头状瘤反复术后狭窄和1例喉淀粉样变致喉狭窄患者行支撑喉镜＋显微镜下激光手术;9例喉外伤后喉瘢痕狭窄患者行喉成形T形管置入术;1例外伤后气管狭窄、3例气管插管后气管狭窄和1例气管乳头状瘤患者行气管成形T形管置入术;2例气管外伤后狭窄和1例气管插管后气管狭窄患者行气管楔形切除端端吻合术;2例甲状腺恶性肿瘤侵犯气管患者在肿瘤根治基础上行袖状切除端端吻合术。分别观察不同术式的手术疗效。结果术后随访时间6个月至3年,2例支撑喉镜手术后复发,长期带管;6例T形管取出后有肉芽组织增生,经激光切除后4例最终拔管;1例2次行T管置入后仍瘢痕形成,最终行气管楔形切除端端吻合术并拔管,1例仍长期带管,其余8例T形管取出后效果良好,顺利拔管;5例气管楔形切除术或袖状切除端端吻合术者,术后均无气管狭窄。结论喉气管狭窄的治疗应根据病因、狭窄的性质、范围、部位制订个体化治疗方案,才可能获得满意的效果。     

Surgical treatment of non-malignant laryngotracheal stenosis

The objectives of this study were the following: (1) to analyze the results of surgical treatment of non-malignant subglottic laryngeal and tracheal stenosis, (2) to evaluate the feasibility and technical aspects of the video mediastinoscopy for the mobilization of the mediastinal trachea, (3) to evaluate the influence of the early internal condition of the anastomosis on the development of restenosis. From 1996 up to 2013, 75 patients aged 11–78 years underwent surgery for post-intubation/tracheostomy (71 patients), post-traumatic (3 patients), and idiopathic (1 patient) subglottic laryngeal and tracheal stenosis. Twenty-three (30.7 %) patients with subglottic laryngeal and upper tracheal stenosis underwent cricotracheal resection and thyrotracheal anastomosis (group A), while 52 (69.3 %) patients with tracheal stenosis underwent tracheal resection and cricotracheal or tracheotracheal anastomosis (group B). The length of the resected segment in patients of groups A and B was 28–55 (42 ± 11) mm and 18–65 (36 ± 14) mm, respectively, (p = 0.22). Perioperative complications within 30 days occurred in eight (34.8 %) patients of group A, and in six (11.5 %) patients of group B (p = 0.04). There was one intraoperative and one postoperative death on the third day due to heart failure. The excellent results were achieved in 63 (86.3 %), satisfactory in 8 (11.0 %), and unsatisfactory in 2 (2.7 %) patients. The incidence rate of perioperative complications is related to the location of the stenosis and the type of the resection and anastomosis. Video mediastinoscopy simplifies the mobilization of the mediastinal trachea, which allows for carrying out the anastomosis with minimal tension. Early internal abnormalities of the anastomosis predict its restenosis.     

42例喉气管狭窄手术治疗分析

目的探讨气管狭窄不同部位、长度、程度及不同狭窄平面最佳手术方式的选择及其疗效。方法回顾性分析2011~2015年我科收治的42例喉气管狭窄患者的临床资料。42例患者中,23例给予支撑喉镜下CO2激光瘢痕切除术,10例给予喉裂开瘢痕切除+T管植入术,2例给予胸锁乳突肌锁骨骨膜瓣喉气管腔重建+T管植入术,7例给予气管袖状切除+端端吻合术。所有患者随访1~6年,观察记录患者的手术次数、拔管时间、术后吞咽进食、活动耐量情况,评估手术疗效。结果42例患者共67次手术,其中激光手术35次,喉裂开瘢痕切除+T管植入术18次,胸锁乳突肌锁骨骨膜瓣喉气管腔重建+T管植入术7次,气管袖状切除+端端吻合术7次。1次性手术治愈24例,2次手术3例,3次手术5例,4次手术1例,5次手术1例,6例长期带管,2例死亡。手术效果理想患者24例,基本理想患者10例,无效8例,手术成功率为80.95%。18例术中置管,12例最终拔管,拔管率为66.7%。术后38例患者伴不同程度的声嘶,所有患者无吞咽困难、饮水呛咳,3例患者出现活动耐量下降。结论术前要对患者病情充分评估,根据狭窄程度、部位、长度,狭窄平面大小,患者身体状况以及是否为瘢痕体质等选择最佳的手术方式,减少手术次数,同时,术后还可以给予适当的辅助性药物治疗,降低复发率。     

Surgical treatment of laryngotracheal stenosis in infants and children

Summary Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi, Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.Presented at the First European Congress of Oto-Rhino-Laryngology and Cervico-Facial Surgery, Paris 26–29 September 1988     

Surgical treatment of laryngotracheal stenosis in infants and children

Laryngotracheal stenosis in children is difficult to manage, especially in cases of acquired lesions. Of 317 cases reviewed, 75 surgical cases are reported here: 28 were congenital and 47 acquired, mostly due to endotracheal intubation. A large variety of laryngotracheoplasty techniques have been used in reconstruction, depending on the age and status of the patient, the size of the laryngeal lumen, the exact site of the stenosis and any associated anomalies. The three main techniques used have been described by Evans, Cotton, and Rethi. Stenting relied on Silastic rolls, Montgomery T-tubes and Aboulker Teflon prostheses. The results in 65 patients showed a decannulation rate of 92% in cases of congenital stenosis and 80% in acquired ones. Improvements in therapy still seem necessary in order to reduce the cannulation time following treatment and the sequelae producing dysphonia.     

Surgical treatment for laryngotracheal stenosis in the pediatric patient

We report our experience with laryngotracheal stenosis (LTS) in children during the last 12 years. Documentation and follow-up were available for 115 patients who underwent surgery for acquired or congenital LTS. Most were severe cases according to Cotton's classification. Forty-six weighed less than 10 kg at the time of surgery; 45 had pure congenital subglottic stenosis; 70 had acquired subglottic stenosis, mainly due to endotracheal intubation. The surgical techniques used have been various. The three main types of procedure were castellated laryngotracheoplasty, anterior cartilage rib grafting, and anterior and posterior cricoid cuts with or without grafting. All cases but 1 (44/45) of congenital subglottic stenosis have been successfully decannulated, 7 requiring a second procedure. The decannulation rate for acquired SGS was 89% (62/70), but 14 patients required multiple procedures. Current trends in subglottic stenosis management in our institution are presented.