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     

儿童喉气管狭窄的病因分析及治疗方法的选择

目的：为提高儿童喉气管狭窄、闭锁的治疗效果。总结了不同部位和范围的狭窄，闭锁患儿的手术方法，方法：共分析了58例儿童喉气管狭窄，年龄15个月－15岁，最多见病因是气管切开术后，其欠有喉气管外伤；复发性喉乳头状瘤术后；气管内插管等。全部病例依靠气管切开通道呼吸，根据喉气管狭窄的范围和程度，采用了不同的喉气管重建术。结果：58例中53例（91．4％）经1－5次手术后治愈，拔除气管套管，恢复正常的呼吸功能，随访1－10年，手术效果巩固，儿童发育正常，结论：正确的掌握气管切开技术可以减少儿童喉气管狭窄的发病率。由于儿童喉气管狭窄病情更加重复杂多变。术中应根据病变的范围和程度选择适当的手术方法，方能获得满意效果。重建喉气管支架和消除粘膜创面是提高疗效的关键。     

儿童喉气管狭窄的病因分析及治疗方法的选择

目的:为提高儿童喉气管狭窄、闭锁的治疗效果,总结了不同部位和范围的狭窄、闭锁患儿的手术方法。方法:共分析了58例儿童喉气管狭窄,年龄15个月-15岁,最多见病因是气管切开术后,其次有喉气管外伤;复发性喉乳头状瘤术后;气管内插管等。全部病例依靠气管切开通道呼吸。根据喉气管狭窄的范围和程度,采用了不同的喉气管重建术。结果:58例中53例(91.4%)经1-5次手术后治愈,拔除气管套管,恢复正常的呼吸功能,随访1-10年,手术效果巩固,儿童发育正常。结论:正确的掌握气管切开技术可以减少儿童喉气管狭窄的发病率。由于儿童喉气管狭窄病情更加复杂多变,术中应根据病变的范围和程度选择适当的手术方法,方能获得满意效果,重建喉气管支架和消除粘膜创面是提高疗效的关键。     

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物重建术等。结果：２６１例中，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病情选择手术方法和移植物；栅栏状喉气管重建术具有方法简单，抗感染力强优点；严重喉气管狭窄、闭锁或合并气管大面积缺损以双蒂肌皮瓣、复合肋软骨和人工气管环重建术效果较好；支撑器的应用在喉气管重建中有重要作用。     

镍钛记忆合金网状支架植入治疗喉气管狭窄

目的探讨镍钛记忆合金网状支架在喉气管狭窄的治疗及颈段气管重建术中的作用。方法回顾6例喉气管狭窄病例用镍钛记忆合金网状支架治疗及2例颈段气管肿瘤行气管切除术后用镍钛网状支架重建气管的临床资料。结果6例喉气管狭窄病人安放网状支架后，均呼吸顺畅；2例颈段气管重建术的病例也获良好疗效。随访11—28个月，呼吸道无狭窄征象。近期有效率100％。结论试用镍钛记忆合金网状支架可使狭窄的喉气管迅速扩张，明显地改善呼吸困难，具有使用方便、见效快、疗效可靠的优点，可作为喉气管狭窄的治疗手段之一，在颈段气管重建术中也有独特的应用效果。     

儿童喉气管狭窄手术方式的选择

目的 探讨不同手术方式对不同类型，不同程度儿童喉气管狭窄的治疗效果。方法 应用瘢痕切除或松解术，瘢痕切除加部分声带切除术，移植物植入喉气管重建术3种手术方法对56例儿童喉气管狭窄进行治疗，其中Ⅲ度以上严重喉气管狭窄50例。结果 52例成功拔除气管套管，治愈率为92.8%。结论 不同程度的儿童喉气管狭窄采用不同手术方式治疗可取得良好治疗效果。     

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     

小儿喉气管狭窄31例发生原因分析

在我们统计 1 978～ 1 999年的 32 0例喉气管狭窄病例中 ,小儿喉气管狭窄达 31例 (约 1 0 % )。可见临床加强对小儿喉气管狭窄的预防是十分重要的事情。本文对 31例小儿喉气管狭窄的致病原因进行分析 ,借以探讨喉气管狭窄的防治方法。报告如下。1　临床资料本组 31例中 ,男 1 7例 ,女 1 4例 ;年龄 3个月～ 1 4岁 ,平均 7岁。按发生原因分类 ,先天性 1例 ,气管切开术后致喉气管狭窄不能拔管 1 2例 ,麻醉插管后致喉气管狭窄 4例 ,外伤后处理不当致喉气管狭窄 7例 ,物理化学烧伤 3例 ,其它 4例 ,住院均在 2次以上。据其狭窄部位范围及程度不同 …     

改良三通气管套管在喉气管狭窄治疗中的应用

喉气管狭窄直接威胁患者的生命安全及身体健康 ,临床一直在寻找一种理想而有效的治疗方法。 1 980年以来 ,我们在切除引起狭窄的病变组织、重建喉气管支架〔1 ,2〕的基础上 ,用改良三通气管套管内固定法扩张治疗 1 3例喉气管狭窄患者 ,经 1～ 5年随访 ,疗效满意。报告如下。1　资料与方法1 .1 　 临床资料本组 1 3例中 ,男 8例 ,女 5例 ;年龄 3.5～ 70岁。病程 2个月～ 8年。因喉气管外伤引起狭窄 5例 ,气管切开术后继发狭窄 3例 ,环甲膜切开后长期戴管狭窄 2例 ,肿瘤切除后狭窄 3例。按Ｃｏｔｔｏｎ( 1 984)喉气管狭窄 4期分度法分期 ,2期 …     

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。     

外伤性喉气管狭窄63例临床分析

目的 探讨外伤喉气管狭窄的手术方式与选择原则.方法 回顾性分析解放军总医院耳鼻咽喉头颈外科1993至2006年共收治外伤性喉气管狭窄患者63例的手术方法与治疗效果.结果 63例患者在该院共行99次针对喉气管狭窄治疗的手术(不包括气管切开、拔管及拔管后的气管造口封闭手术),每例患者平均经历1.9次手术;经1次手术者40例(占63.5%),经2次手术者15例(23.8%),3次手术者5例(7.9%),4次手术者2例(3.2%),经历6次手术者1例(1.6%).对首次入院时判断为喉软骨支架完整而行支撑喉镜手术15例,11例1次手术成功.软骨支架骨折、狭窄严重者,首次单纯喉气管裂开T管置入36例,经单次手术成功拔管者20例(55.6%);喉气管裂开、腔内植皮+T管置人术10例,拔管7例(70%);喉气管裂开T管置入、带蒂舌骨喉气管软骨缺损修复共6例,拔管4例(4/6).声门下及气管的局限性狭窄采用狭窄部气管或环状软骨部分切除、端端吻合术9例,7例单次手术拔管(7/9).2例卢门下狭窄并气管食管瘘修补均一次成功,拔除气管套管.患者随访6个月～5年,57例拔管后均呼吸通畅,无误吸,无再狭窄,但嗓音沙哑;6例拔管失败,拔管率为90.5%.结论 外伤性喉气管狭窄治疗比较困难,需根据术前伞面检查,准确评估喉气管支架缺损情况、狭窄的程度和受累的范围,选择恰当的手术方式.     

Laryngotracheal reconstruction in infants and children: are single-stage anterior and posterior grafts a reliable intervention at all pediatric hospitals?

Objective

To review outcomes of pediatric laryngotracheal stenosis treated by single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts and compare decannulation rate for single-stage laryngotracheal reconstruction with rates published at larger (>200 beds) pediatric tertiary care hospitals.

Methods

A 4-year retrospective chart review (2004–2008) of all patients undergoing procedures coded with 2008 CPT codes 31582 (laryngoplasty for laryngeal stenosis with graft or core mold, including tracheotomy) and 31587 (laryngoplasty, cricoid split) for a pediatric, tertiary-care hospital. Interventions were single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts, and the main outcome measure was the decannulation rate after single-stage laryngotracheal reconstruction.

Results

We identified 44 patients with subglottic stenosis, of whom 13 underwent single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts. The mean age at surgery was 2.2 years (range, 5 months to 4 years). Twelve of 13 children had Cotton-Myer grade III stenosis. Ninety-two percent (12 of 13) of children remain decannulated. The mean follow up was 52 months.

Conclusions

Single-stage laryngotracheal reconstruction with anterior and posterior cartilage grafts appears to be a safe and effective technique for managing patients with high-grade subglottic stenosis at intermediate size children's hospitals. Our overall decannulation rate of 92% compares favorably to that reported in the literature (84–96%).     

Outcome of endoscopic management of extensive laryngotracheal stenosis

OBJECTIVES: When performing endotracheal intubation or tracheotomy in unconscious patients in emergent situations, one should consider the possibility of the later complication of laryngotracheal stenosis, which can result in difficulties with decannulation. We analyzed the clinical features of laryngotracheal stenosis to search for its possible etiologic factors and its proper preventive methods. METHODS: The medical records of 249 cases of laryngotracheal stenosis out of 2,208 patients who underwent tracheotomy in our hospital during the past 12 years were retrospectively reviewed regarding several parameters, such as the duration of endotracheal intubation, site of tracheostoma, site of stenosis, treatment method, and so forth. RESULTS: Non-otolaryngologists had a tendency to place the tracheostoma at a higher level of the trachea. We identified technical precautions that should be taken into consideration in performing an emergency tracheotomy. Bronchoscopic evaluation and tracheal stent insertion was the most commonly used treatment method. Successful decannulation was achieved in about 70%, and was especially frequent in patients whose endotracheal intubation was less than 20 days. CONCLUSIONS: It is desirable that the duration of endotracheal intubation be limited to less than 20 days. A database of patients who undergo tracheotomy should be submitted to careful follow-up to diagnose early development of laryngotracheal stenosis and to prevent long-term complications.     

Partial cricoid resection with primary tracheal anastomosis for subglottic stenosis in infants and children

Fifteen infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary tracheal anastomosis. The etiology of the stenosis was congenital in 3 cases and was acquired after prolonged intubation in 12. Fourteen patients were tracheotomy dependent at the time of surgery, and 13 (87%) of the 15 were classified grade III (7 cases) and IV (6 cases) according to Cotton. The resection included the cricoid only in 5 cases and the cricoid and a segment of trachea (1 to 4 rings) in 10 cases. Decannulation was achieved after a single open procedure in 14 (93%) of the cases. The authors encountered no lesion of the recurrent laryngeal nerves and no fatalities. There was, however, 1 restenosis. Twelve cases were decannulated within 6 months, most of them at 2 months. The postoperative voice is normal in 10 cases, and a slight dysphonia is present in 4 cases. Twelve patients show no exertional dyspnea, and 2 exhibit a slight stridor while practicing sports. Ten of 14 cases have been followed for more than 5 years, with the longest follow-up now being 14 years. In all cases, the laryngotracheal development is normal. The results of this small series compare favorably with those of laryngotracheoplasty procedures usually performed for subglottic stenosis in infants and children. In the future, partial cricoid resection with primary tracheal anastomosis should be considered as an important treatment option for severe subglottic stenoses in infants and children.     

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。     

Laryngotracheal stenosis in children

The diagnosis of laryngotracheal stenosis should be suspected in children with stridor, feeding difficulties, or atypical croup. Only half of the children with congenital laryngotracheal stenosis require tracheotomy, and many of these children can be decannulated following uncomplicated surgical therapy. In contrast, tracheotomy-dependent patients with acquired laryngotracheal stenosis require more extensive surgical intervention, which should be carried out as early as possible to provide the best opportunity for developing normal oral communication. Received: 8 March 1977 / Accepted: 31 July 1997     

环状软骨前后裂开加移植物治疗儿童喉气管狭窄

目的：探讨环状软骨前后裂开加移植物对儿童喉气管狭窄的治疗效果。方法：回顾性分析我院近10年来采用环状软骨裂开喉气管成形术治疗的儿童喉气管狭窄12例,年龄6～15岁,平均8岁。全部病例术前均依靠气管切开通道呼吸。结果1全部病例中,11例（91．7％）治愈拔管,恢复正常呼吸功能及功能性发声。随访1～10年,疗效可靠,儿童生长发育正常。结论：环状软骨前后裂开加移植物治疗儿童喉气管狭窄可取得良好的治疗效果,对儿童的生长发育无明显影响。     

Update of the Cincinnati experience in pediatric laryngotracheal reconstruction

Surgical endeavors in the field of laryngotracheal reconstruction in children have received much interest in the past 15 years. A unique experience with laryngotracheal reconstruction in 203 children is reviewed. The majority (194) of the cases were classified as acquired; only nine were classified as congenital. Excluded from the study were those cases of stenoses managed endoscopically, all resections and end-to-end anastomoses, all anterior cricoid split procedures, and all cases of anterior glottic stenosis repaired by a laryngeal keel. The degree of stenosis was graded into four categories. Five different methods of laryngotracheal reconstruction were used depending on the pathologic lesion in the larynx and trachea. Of the 203 children, 186 (92%) were decannulated. The results support the use of laryngotracheal reconstruction in children with grades 2, 3, and 4 laryngeal stenosis.     

自制喉扩张模在预防外伤性喉气管狭窄中的应用

目的研究自制喉扩张模在预防严重喉气管损伤术后喉气管狭窄的疗效,探讨放置喉扩张模的时限。方法1992年1月～2004年12月收治严重喉气管损伤患者26例,其中闭合性损伤7例,开放性损伤19例,全部行气管切开、创伤探查及喉气管成形术。根据喉气管管腔大小和形状,用医用热凝塑料制成喉模,放置于喉腔。喉扩张模的膨大部分超过狭窄部位5mm以上,上端不超过杓状软骨平面,峡部位于声门裂处,用粗丝线上端从鼻腔引出,固定于面颊部;下端由气管切开口引出到颈外,固定于气管套管底座上,关闭喉腔,颏胸固定。结果26例患者均于术后2～3个月顺利拔除喉模和气管套管,带喉扩张模期间无严重并发症。24例患者伤口一期愈合;2例伤口感染,二期愈合。术后随访1年以上,除1例出现声门下狭窄外,其余25例气管通畅,发声满足日常交流,均未出现喉气管狭窄。结论使用医用热凝塑料制作喉扩张模放置2～3个月,可有效预防外伤性喉气管狭窄;且制作简单,可实现个体化,组织相容性好,费用低廉。