闭合性喉气管断裂的诊治体会

探讨闭合性喉气管断裂的发病机理、临床特点及急救原则。方法：诊治了８例严重闭合性损伤致喉气管断裂的患者，男６例，女２例，年龄１３－３６例，平均２４岁。     

外伤性闭合性气管断裂伤4例报告

喉、气管外伤临床并非少见，但单纯闭合性气管断裂伤则少见，我院自１９９２年至１９９８年收治４例，报告如下。１病例报告 例１，男，１８岁。因骑自行车在冰冻路上不慎滑倒，自行车小把扎伤颈前部，当即呼吸困难，面色青紫，半小时后来院，心跳呼吸停止，瞳孔散大。检查见颈前相当于环状软骨处有－１ｃｍ紫瘢，触及气管环凹陷，直接喉镜下见喉腔内少许瘀血，声门闭锁，气管镜撑开声门见环状软骨及第二气管环碎断，气道阻塞，无皮下气肿。 例２，男，２３岁。例３，男，３１岁。两例均因骑摩托车与机动车相撞，摩托车倒车镜柄扎伤颈前部一…     

儿童气管切开术致喉气管狭窄及其手术治疗

报道儿童气管切开术引起喉气管狭窄15例,分析其原因主要有:①由于切口小、套管粗,将气管前壁软骨环压入气道;②气管切开口位置过高;③气囊压迫使局部坏死、瘢痕形成。认为早期行成形手术对儿童喉气管发育无影响;严格掌握适应证,正确熟练地进行技术操作和合理使用抗生素对预防发生喉气管狭窄至关重要。     

闭合性颈部外伤并喉气管分离患者的紧急救治

闭合性颈部外伤并喉气管分离为一严重但不常见的喉外伤，我们诊治3例。现报告如下。     

气管插管及气管切开术后急性喉气管狭窄的诊治

因危及生命而在复苏室行气管插管或紧急气管切开术后,常因长期插管及气囊压迫致成喉气管狭窄(LTS),约占LTS病因中的20％-25％。作者复习1990-2001年间这类患者2000例中1800例均无并发症而顺利除管,200例(男120,女80例,16-75岁)在     

严重颈部闭合性损伤致喉气管断裂的救治体会（附8例报告）

从１９７６年１２月至１９９６年９月，我们救治了８例严重闭合性损伤致喉气管断裂的患者，男６例，妇２例，年龄１３￣３６岁，平均２４岁。结果２例死亡，１例死于出血窒息，另１例尚未来得及手术而死亡；１全甸救治不当发生气管狭窄而需进一步整复，其余５例恢复了喉的功能。强调在修复中应最大限度地保留破碎的软骨膜、软骨和粘膜。本文重点讨论了颈部闭合性损伤致喉气管断裂的发病机理，临床特点及急救原则。     

一期整复手术治疗喉气管外伤45例

目的通过分析一期整复手术对喉气管外伤患者喉气管功能恢复的影响,探讨喉气管外伤合理的救治方法。方法对45例喉气管外伤患者均施行一期喉气管探查术,其中闭合性喉气管外伤15例,开放性喉气管外伤30例。结果术后顺利拔管40例,其中仍有声嘶12例;未能拔管4例,术后均发生喉狭窄,其中2例经二次手术喉内放置硅胶管扩张后拔管,2例喉腔肉芽生长反复多次钳取、激光切除,致瘢痕狭窄再行手术,延迟拔管;1例吻颈患者在行喉气管整复术后放弃治疗,2?d后死亡。结论在处理喉气管外伤中应尽可能一期重建喉气管的结构,保留、恢复患者的喉气管功能,早期正确处理是防止喉狭窄的关键。     

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。     

喉气管瘢痕性狭窄113例的治疗体会

报告经治喉气管瘢痕性狭窄１１３例。结果表明：直接喉气管镜下间歇扩张法是治疗儿童喉气管狭窄的主要方法；硅橡胶Ｔ型管置入法是治疗成人喉气管瘢痕狭窄的简便、有效方法；对喉气管软骨支架缺损较多的严重狭窄，采用带蒂舌骨转位术治疗，可获得较好疗效。针对发病原因提出：婴幼儿的气管切开术应严格掌握好适应证，注意正规操作。颈外伤早期正确处理是预防喉气管瘢痕性狭窄的关键。     

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管狭窄病变而定。     

Treatment of laryngotracheal stenoses in children

Over a period of 5 years, from 1984 to 1989, 35 children were treated surgically for a laryngo-tracheal stenosis, 27 by an external approach, 8 by endoscopy with the CO2 laser. Of the children, 25 (71%) were under 5 years old at the time of treatment and 77% of the stenoses (n = 27) corresponded to a post-intubation and/or tracheotomy acquired etiology. Based on the classification of stenoses according to the extent of the impairment of the aerial lumen, the authors stress the value of conservative treatment (endoscopy) in Stage I (less than 70%, n = 8), and of treatment using the external approach in Stage II (between 70% and 90%, n = 12), in Stage III (between 90% and 99%, n = 12) and Stage IV (complete obstruction, n = 3). The technique most widely used currently is laryngo-tracheoplasty with the insertion of costal cartilage (n = 17). Analysis of the results shows that decannulation was successful in 85% of the cases. With respect to the management of stenoses in the new-born baby, the authors report on their recent experience with laryngo-trachoe-fissure in 6 cases as an alternative either to tracheotomy in difficult extubations, or to laryngo-tracheoplasty when the child's weight is particularly low.     

Pediatric laryngotracheal separation following a go-cart injury

Less than one percent of trauma admission cases are categorized as pediatric neck trauma [13]. Nevertheless, due to an increasingly mobile society, there has been an increasing frequency of pediatric neck trauma with motor vehicle accidents being the most common mechanism of injury [8].We present a case of laryngotracheal separation from a blunt, clothesline injury to the neck in a pediatric patient. We also review the literature and discuss the benefit of balloon airway dilation and its assistance in the management of laryngeal trauma and its resultant effects.     

复发性多软骨炎并发喉气管狭窄

目的分析复发性多软骨炎(relapsing poly- chondritis,RP)并发喉气管狭窄的临床特点和预后。方法回顾性分析1996～2006年间我院收治的6例RP并发喉气管狭窄患者的临床资料。结果6例RP并发喉气管狭窄患者,喉气管狭窄范围弥漫广泛,其中4例应用带蒂或游离组织移植行喉气管成形术,2例行胸段气管扩张术。5例手术成功,效果巩固未复发。结论因RP并发喉气管狭窄的病例,治疗更加棘手,但是如根据病情选择适当的手术时机和方法仍可取得满意的疗效。     

Total idiopathic laryngotracheal stenosis. Treatment with mitomycin C

This case report involves a 69-year-old woman who presented idiopathic laryngotracheal stenosis with total obstruction of the airway. Seven surgical procedures involving open field and endoscopy techniques had to be performed due to repeated re-obstructions. The novelty in this case is that success was finally obtained with the use of mitomycin C. The drug action is well known, but is interesting to report a case in which success was only obtained when we used mitomycin C.     

Treatment of stenoses of the laryngotracheal junction and the cervical trachea

In the past 20 years we have operated on 187 patients for tracheal stenoses. Dilatation, tracheopexy with ring support, sleeve resection, and the gutter procedure are described. In recent years we have replaced open treatment of the tracheal gutter with our closed method. After expanding the posterior wall, the anterior tracheal wall is closed with a myocutaneous island flap, rib cartilage or a myomucosal flap. The merits of the different methods are discussed. Dilatation of the trachea and reconstruction of the anterior tracheal wall over a silicone tube in a one stage procedure creates a sturdy trachea, which is better able to resist scar contracture and pressure from the soft parts of the neck than an open U-shaped gutter. The number of operations and days of treatment per patient are materially reduced by the closed method.     

Penetrating laryngotracheal injury in a child: An unusual case of firework fragment

Firework explosives injuries manifest usually as a blast or burn injuries. We describe an extremely rare case of penetrating laryngotracheal blast injury in a teenager. Dilemmas in diagnosis and management, especially of the airway, will be discussed.     

探讨肋软骨瓣移植成形术治疗重症喉气管狭窄成败原因

目的探讨应用肋软骨移植喉气管成形术治疗重症喉气管狭窄成败原因,提高喉气管狭窄成形术技术.方法回顾分析第四军医大学唐都医院1983～2001年采用喉气管裂开移植肋软骨治疗重症喉气管狭窄患者36例病情及治疗结果,研究其成败原因及解决方法.结果 36例中29例(80.5%)一次成形术成功治愈,拔除气管切开套管,恢复正常呼吸,经1～10年随访,疗效巩固.7例失败未愈.失败原因局部皮肤血循环差(大剂量放射治疗后,反复多次手术局部瘢痕重),伤口感染软骨坏死排出,T形管损伤黏膜形成新的瘢痕狭窄和瘢痕体质.结论用肋软骨瓣移植术治疗严重或比较严重的喉气管狭窄方法简单,带T形管时间短,疗效好.缺点是增加一个手术切口,游离肋软骨容易发生缺血性坏死,颈部皮肤放射治疗后及瘢痕体质者慎用此法.选择好适应证,术后加强护理,正确应用支撑器可以提高疗效.