镍钛记忆合金支架治疗喉气管狭窄

目的　探讨镍钛记忆合金支架在喉气管狭窄治疗中的作用。方法　回顾 14例喉气管狭窄病例用镍钛记忆合金支架治疗的临床资料。结果　 14例喉气管狭窄 ,安放支架后 ,均呼吸畅顺 ,同期封闭气管造瘘口。随访 2～ 12月 ,呼吸道无狭窄征。近期有效率 10 0 %。结论　镍钛记忆合金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常规手段之一。     

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。     

镍钛记忆合金支架治疗颈段气管狭窄43例

目的探讨镍钛记忆合金支架治疗颈段气管狭窄的适应证、方法、并发症以及注意事项。方法回顾分析镍钛记忆合金支架治疗颈段气管狭窄43例患者，其中肿瘤压迫致气管狭窄15例；外伤性气管狭窄7例；肉芽增生4例，包括1例Wegener肉芽肿，2例鼻硬结病，1例不明原因炎性肉芽增生；复发性多软骨炎7例；1例(支)气管淀粉样变；4例(支)气管内膜结核；5例气管软化。狭窄程度：Ⅰ期15例，Ⅱ期24例，Ⅲ期4例。5例狭窄上端延至声门下。结果42例患者置入支架后，呼吸困难立即改善；1例因为术中意外中止手术。26例带管者中18例术后3—4d拔除气管套管和封闭颈前气管造口；8例未能同期除管者中3例喉裂开术后带管出院，1例患者术中出现呼吸心跳骤停而终止手术后转科治疗，2例支架移位使呼吸困难缓解不明显，2例支架上口肉芽增生阻塞气道，二次手术去除肉芽组织。支架位于声门下的5例患者术后3例有轻度误咽，1例声音嘶哑，通过调整进食姿势等逐步适应，误咽症状减轻。结论镍钛记忆合金支架可迅速扩张气管狭窄，明显改善呼吸困难，具有手术微创和操作简单的优点，可以作为气管狭窄治疗手段之一。     

镍太记忆合金支架治疗食管狭窄

目的：探讨镍钛记忆合金（ＮＴ－ＳＭＡ）支架在治疗食管狭窄中的应用价值。方法：在Ｘ线下了解食管狭窄的部位,经食管镜插入金属导丝,先行食管扩张术,再将装有支架的置入器沿导丝滑入食管狭窄处,放出ＮＴ－ＳＭＡ支架,并让其自行复形,术后Ｘ线吞钡复查了解支架位置和通畅情况。结果：１９例食管狭窄患者,安放支架均一次成功,恢复进食功能,近期有效率为１００％。结论：ＮＴ－ＳＭＡ支架可使狭窄的食管迅速扩张,明显地改善     

应用扩张管治疗重度喉气管狭窄

目的探讨重度喉气管狭窄选用不同扩张管的临床价值。方法将14例重度喉气管狭窄的患者,依据狭窄的部位、长度、程度及软骨损伤情况,分别采用置入＂T＂形硅胶管10例、镍钛记忆合金支架2例和气管切开气管插管2例,扩张管均留置6个月以上。结果术后随访1～10年,10例置入＂T＂形硅胶管患者中,9例拔管后恢复通气及发音功能,进食无呛咳,1例术后拔管后又出现呼吸困难,二次置管,该患者拒绝拔管,随诊3年通气好,轻度声嘶;2例置入镍钛记忆合金网状支架患者通气好,无呼吸困难,轻度声嘶;2例气管切开插管患者,经放疗解除淋巴结压迫后,拔管后,呼吸、发音良好。结论依据喉气管狭窄的长度、部位、程度及破坏程度,选择恰当的扩张管能够取得较为理想的疗效。     

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。     

脱细胞真皮基质黏膜组织补片在咽部修复中的应用

目的 探讨脱细胞真皮基质黏膜组织补片（acellular dermal matrix，ADM）在咽部的修复作用。方法 2003年6月—2004年12月对18例患者行口咽、喉咽癌切除术，其中4例肿瘤原发于口咽和喉咽后壁，保留喉功能切除肿瘤，用ADM重建口咽和喉咽后壁；3例肿瘤原发一侧梨状窝侧壁和咽后壁，声带活动正常的，保留喉功能行咽后壁或侧壁切除术，将ADM缝在椎前筋膜和咽侧壁上关闭咽腔，用保留的胸锁乳突肌加固；对11例肿瘤累及颈段食管，声带活动受限及固定者，行喉全切除或喉咽全切除术，将ADM缝在椎前筋膜上重建喉咽后壁，用胸大肌肌皮瓣重建喉咽前壁和侧壁，重建密闭腔道。术后全部患者进行放射治疗，放疗剂量60～70Gy。结果 18例患者术后未发生排异反应，无咽瘘，创面均黏膜化。2例患者切口皮下感染，经换药后伤口愈合。所有患者均可经口进食。7例保留喉的患者恢复了喉功能，拔除气管套管，但其中3例进食流质时有轻度误咽。术后随访12～30个月，中位随访时间为19．38个月，补片移植区无排异反应、瘢痕和挛缩。随访18月以上11例，其中3例肿瘤复发，1例再次手术后健在，2例死于全身转移。结论 ADM来源方便，组织相容性好，厚薄适宜，手术操作简便，可联合胸大肌肌皮瓣或其他颈部组织修复咽部环周缺损，是一种新的安全有效的修复材料。     

Development of the larynx and trachea following division of the cricoid cartilage and segmental resection of the trachea in the growth stage. An animal experiment study

Laminotomy as described by Réthi, and segmental tracheal resection with end-to-end anastomosis have proved useful in the adult for the treatment of stenoses of the larynx. In children, the question arises why these may interfere with the growth of the larynx and trachea. A vertical split of the cricoid cartilage followed by stabilization of the larynx by the temporary introduction of a Montgomery silicone T-tube was carried out on four kittens aged four to six weeks. A segmental tracheal resection with end-to-end anastomosis was performed on other animals of the same age. When the animals had stopped growing, the larynx and trachea were investigated both endoscopically and histologically. Following laminotomy the larynx underwent remodelling, resulting in an oval shape, the lumen being wide and the function of the vocal cords normal. Following segmental resection of the trachea, a circular stenosis was found, as a result of irregular growth of the sutured tracheal cartilages. In none of the animals, however were either functional disorders or respiratory distress to be observed. Thus, laminotomy or segmental resection of the trachea can be employed during the formative years without fear of clinically relevant growth disorders.     

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。     

Carcinomas of the thyroid gland invading larynx and trachea

Twenty-nine patients with a thyroid carcinoma invading the larynx and trachea were treated over a 25-yr period. Eight patients had invasion of the walls of the trachea or larynx and 21 had invasion into the lumen. Of the 15 patients who underwent limited surgery, i.e. total thyroidectomy, tracheostomy and neck dissection, 8 had intraluminal invasion and 7 suffered from bleeding into the trachea or airway obstruction. In contrast, none of the 13 who underwent extensive surgery, i.e. thyroidectomy, laryngectomy, partial resection of the trachea and one resection of the pharynx, (12 of whom had intraluminal invasion) showed either bleeding into the trachea or airway obstruction. Although the prognosis was no better in the group undergoing extensive operation there is the feeling that in cases with intraluminal invasion extensive surgery is indicated to prevent the severe airway difficulties which often develop in such patients.     

闭合性喉气管损伤诊断与治疗探讨

目的探讨进一步提高闭合性喉气管损伤诊断与治疗水平的措施。方法分析32例闭合性喉气管损伤患者的临床资料,对相关问题进行讨论。结果32例闭合性喉气管损伤病例,2例死亡,1例因救治不当发生喉气管狭窄而需进一步整复,其余29例恢复了喉的功能。结论对喉气管外伤准确分度,在修复术中最大限度地保留破碎的软骨膜、软骨和粘膜是提高近期疗效、预防后期喉狭窄的关键。     

腺外浸润的晚期甲状腺癌的外科治疗

为评价腺外浸润的晚期甲状腺癌的手术疗效和预后,回顾性分析了16例手术治疗的甲状腺癌病例,其中侵及范围为气管、食管、喉、喉返神经、下咽和颈部大血管等。1例行根治性手术,其它均行功能性手术,对喉、气管、食管及下咽的缺损进行了修复重建。全部病例均有1年以上的随访。结果发现,11例喉气管重建者均拔管;2例下咽食管成形者吞咽功能良好。1例术后4年双肺转移死亡,余15例未发现复发及转移。其中生存1年、3年、5年、10年和15年者分别为16例、14例、7例、3例和1例。探讨了晚期甲状腺癌腺外浸润范围对确定手术方式的意义及术后综合治疗的重要性。尽管晚期病变腺外浸润周围诸多重要器官和结构,但积极行功能性外科手术仍有助于提高疗效及患者生存质量。     

长期失喉者的喉再造术

目的 为了恢复长期失喉患者的喉功能。方法 １９９０年１０月～１９９９年１１月共行喉再造手术３４例，男３３例，女１例。年龄最大７７岁，最小２７岁，平均５６．６岁，喉全切除术后３３例，其中喉鳞癌３１例，喉横纹肌肉瘤１例，甲朱癌累及喉１例，喉外伤后１例。失喉的时间为２～７２个月，平均１８个月。手术特点是：用颈部肌皮瓣连结咽和气管，同时充当会厌，力求达到能发音、呼吸和无明显呛咳的目的。结果 全部患者发音清     

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月到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,女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例因救治不当发生喉气管狭窄而需进一步整复,其余5例恢复了喉的功能。强调在修复术中应最大限度地保留破碎的软骨膜、软骨和粘膜。本文重点讨论严重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。     

喉气管腺样囊性癌10例临床分析

目的 探讨喉气管腺样囊性癌的临床特点、治疗方法及预后。方法 回顾性分析10例行喉气管腺样囊性癌的临床资料,根据UICC　2002年TNM分期标准,喉腺样囊性癌T1N0M0 1例,T2N0M0 1例,T3N0M0 3例;根据Bhattacharwa分期,气管腺样囊性癌T1N0M0 1例,T2N0M0 3例,T3N0M0 1例。10例患者临床上以喉痛、声嘶、咳嗽及进行性呼吸困难伴喘鸣等为主要表现形式,采取手术加术后辅助放疗的治疗模式。喉腺样囊性癌以喉全切除术和喉部分切除术为主,气管腺样囊性癌以气管袖状切除加端端吻合术为主。术后辅助放疗,采用调强放疗方式,总剂量 60～70Gy。结果 10例患者术后愈合好,无并发症,随访时间为2个月～7年不等,所有病例均未见局部复发及远处转移。结论 喉气管腺样囊性癌临床上以进行性呼吸困难伴喘鸣、咳嗽及声嘶为主,纤维喉镜检查有利于早期发现。该病颈淋巴转移率低,预后较好。根治性切除加术后辅助放疗是治疗喉气管腺样囊性癌的最佳方法。     

部分去黏膜游离空肠重建长段气管后肠黏膜组织学研究

目的：通过建立部分去除黏膜层的带蒂游离空肠段重建6．5cm袖状气管缺损动物模型,研究部分去黏膜空肠重建气管后空肠黏膜层的组织学变化。方法：比革犬8只,在制作好带蒂部分去黏膜游离空肠段后,肠腔内放置硅胶管内支架,空肠外面放置形状记忆镍钛合金外支架,切除犬的6．5cm长袖状气管后,将肠系膜动静脉分别与右侧颈总动脉、颈内静脉相吻合,重建气管缺损。术后分别于1、2、3、4个月各处死2只犬,于吻合口和移植空肠肠腔中部取活检,标本行光镜及电镜观察。结果：8只犬术后全部生存到预期时间,移植游离空肠全部成活。组织学观察术后1个月时空肠段重建气管的上皮层大量缩短的小肠绒毛,绒毛间有大量的纤维素性渗出和炎性细胞。术后2个月时小肠的绒毛明显稀疏减少、长度明显缩短,腺体萎缩,腺腔缩小,肠黏膜上皮层明显变薄。术后3个月时移植空肠腔上皮基本化生为鳞状上皮,4个月时移植空肠内腔部分鳞状上皮化生为假复层纤毛柱状上皮。结论：部分去黏膜游离空肠重建长段气管后可以加速肠腔黏膜层的萎缩及化生过程,3个月可见肠腔黏膜层化生为鳞状上皮、4个月时有部分鳞状上皮化生为假复层纤毛柱状上皮。     

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。     

Characteristics of postoperative healing in patients with stenoses of the hollow organs of the neck (clinico-morphologic study)

In 160 patients, postoperative healing of stenoses of hollow neck organs of various etiology was examined clinically and morphologically. All the patients were divided into 4 groups in terms of the etiological factor as follows: Group 1 (60 patients)--patients with post-traumatic stenoses of the larynx and trachea; Group 2 (34 patients)--patients with post-resuscitation stenoses of the larynx and trachea; Group 3 (38 patients)--patients with bilateral laryngoparalysis that developed after strumectomy; Group 4 (28 patients)--patients with postburn deformation of the pharyngolarynx and esophagus. Pathomorphological changes typical of a chronic inflammatory process were detected in the frontal neck tissues (skin, muscles, cartilages, mucous membrane) of all the patients. Morphologically, the frontal neck tissues were similar in all the patients. In view of this, a large number of suppurative-necrotic complications seen after surgery of stenoses of hollow neck organs (up to 45%) can be attributed to pathological lesions in the frontal neck tissues.     

Airway obstruction due to lymphoma of the larynx and trachea

Involvement of the larynx and trachea by lymphoma is an uncommon problem that can cause life-threatening airway obstruction. High grade obstruction, involvement of the soft tissue of the neck, and tracheal deviation can make intubation and tracheotomy hazardous, if not impossible. Tracheotomy can be ineffective with obstruction of the distal trachea. The clinical presentation and treatment of eight patients with lymphoma involving the larynx or trachea are presented with emphasis on airway management. Dramatic tumor response with relief of airway symptoms was achieved with a regimen of radiotherapy, chemotherapy, corticosteroids, helium-oxygen mixtures, humidity, and intensive care unit monitoring. Direct airway intervention, including tracheotomy, was usually successfully and safely avoided.     

End-to-end anastomosis in chronic tracheal stenosis

Objective: This study assessed the efficacy and safety of end-to-end anastomosis of the trachea following segmental resection in chronic tracheal stenosis. Methods: End-to-end anastomoses of the trachea were performed in 35 patients with chronic tracheal stenosis; 18 patients with tracheal invasion of thyroid cancer and 17 patients with long-term intubation and blunt injuries of the trachea. Results: All operations were successful, except one whose unilateral recurrent nerve had not been identified in the recurrent thyroid cancer invasion with trachea. Conclusion: This operation provides a one-step cure for the stenosed trachea and can be applied to the resection of less than six tracheal segments.