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。     

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、     

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。     

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。     

喉气管狭窄合并气管食管瘘I期手术治疗

目的探讨喉气管狭窄合并气管食管瘘患者的I期手术治疗效果。方法回顾性分析2007年3月-2017年3月诊治的喉气管狭窄合并气管食管瘘患者共6例的手术方式和治疗效果。根据喉气管狭窄范围和程度的不同,行喉气管狭窄切除,分别采用气管-甲状软骨、气管-环状软骨或气管-气管端端吻合术,并I期行胸骨舌骨肌筋膜瓣转移加强修补食道瘘孔。结果所有患者气管食管瘘均I期愈合。5例患者拔除气管套管,呼吸功能恢复良好,仅1例患者未能拔除气管套管。结论对于喉气管狭窄合并气管食管瘘的患者,可以行I期气管食管瘘修复并喉气管狭窄切除,根据狭窄部位的不同,采用气管-甲状软骨、气管-环状软骨吻合术或气管-气管端端吻合术,可以取得良好的效果。     

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     

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.     

The rotary door myocutaneous flap. A reliable technique for laryngotracheal reconstruction

We examined the possible uses of the "rotary door" sternohyoid myocutaneous flap (RDF) in laryngotracheal reconstruction. This well-vascularized myocutaneous flap, when rotated axially, can replace or widen the anterolateral walls of the airway. It provides a large epithelial surface, together with bulky structural support. The flap is readily available within the immediate surgical field and can replace large defects in the airway, from the level of the glottis to the cervical trachea. After extensive structural and soft-tissue loss of the larynx and trachea were produced to simulate commonly encountered traumatic and postsurgical stenotic conditions, the RDF was employed in 23 dogs in a single-stage laryngotracheal reconstruction. A stable, widely patent airway was achieved. The dogs were followed up for periods varying from three to six months. No complications or secondary stenoses were encountered. Photographic, radiologic, and endoscopic examinations demonstrated the viability and usefulness of this newly described flap. Long-term tracheostomy was used so that intraluminal stents and cannulas could be avoided. Histopathologic studies confirmed the integration of the RDF into the framework of the larynx and trachea. Application of this technique in cases of tumors, trauma, and stenosis of the airway is suggested.     

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。     

Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988–1998 Teil II: Die cricotracheale Resektion

Approximately 90% of infants and children with severe acquired laryngotracheal stenoses are tracheotomy dependent and therefore impaired in their physical and speech developments. In addition, tracheotomized infants can be endangered by the cannula due to the possible crusting of secretions or its dislocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotracheal stenoses. Ten children were treated with a modified Cotton technique. This paper reports our results of cricotracheal resection performed in 8 children since 1994 (age distribution: 7 months through age 15 years). Four children had Cotton grade II stenoses, three had grade III stenoses and one grade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfully decannulated. Five children without tracheotomies could be extubated uneventfully on the 5th postoperative day. All three primarily tracheotomized children needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally required a tracheoplasty with rib cartilage grafts in order to stabilize the suprastomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All children's voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this effective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.