喉科学

20050069闭合性喉气管损伤诊断与治疗探讨/ 路学美…//中国耳鼻咽喉头颈外科.2004,11(3) .165～166 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、软骨和黏膜是提高 近期疗效、预防后期喉狭窄的关键。参4(蔡超) 20050070声带注射得保松治疗慢性肥厚性喉 炎/黄益灯…//…     

闭合性喉气管损伤的诊断与治疗的经验

随着交通事故、工伤及各种意外事件发生率增高，喉外伤发病率也日益增加。由于临床对急诊期闭合性喉气管软骨及黏膜损伤的严重性估计不足、处理不当易产生严重并发症，如喉狭窄。因此，闭合性喉气管损伤的处理较之开放性损伤难度更大。1976年12月～2002年9月我们共诊治闭合     

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。     

闭合性喉气管损伤手术指征与手术时机的探讨

目的 探讨闭合性喉气管损伤的手术指征和手术时机,减少喉气管狭窄形成.方法 回顾性分析1988年1月～2008年1月来我科就诊的33例闭合性喉气管损伤患者的临床资料,其中7例为急性损伤,26例为因闭合性损伤导致的不同程度的喉气管狭窄,对所有患者的相关问题进行分析及讨论.结果 7例急性损伤中,6例在伤后24 h内行喉气管探...     

严重喉气管外伤的一期整复手术治疗

喉气管外伤分为闭合性和开放性。轻度的损伤一般采用简单的清创缝合或密切观察下抗炎、消肿治疗。严重者指外伤造成急性喉梗阻、进行性皮下气肿、喉气管软骨塌陷及粉碎性骨折、喉气管断裂等需紧急气管切开者，应即刻手术探查，这样既避免或减少了喉狭窄的发生，又能彻查病情，避免误诊而延误治疗。我们总结了32例严重喉气管外伤的一期整复手术治疗的治疗经验，报道如下。     

重症喉气管闭合性损伤3例

目的 提高重症喉气管闭合性损伤的诊治水平.方法 回顾性分析3例重症喉气管闭合性损伤病例的临床资料.结果 3例诊断除据临床表现外均行手术探查证实,全部治愈且无喉狭窄发生.结论 对严重呼吸困难、怀疑有喉气管损伤的患者,早期行手术探查是提高近期疗效、预防后期喉狭窄的关键.     

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。     

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。     

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。     

喉气管创伤33例临床分析

为了提高喉气管创伤治疗水平，本文对1960年经住院治疗的33例喉气管创伤临床资料进行回顾性分析。创伤程度Ⅱ型12例，Ⅲ型17例，Ⅳ型4例，28例气管切开。闭合伤中注意诊断。开放伤Ⅲ、Ⅳ型中喉软骨暴露破损5例，有4例喉狭窄，1例早期预防性喉扩张术未发生喉狭窄，1例咽瘘的发生和治疗等进行分析，认为喉气管创伤必须提高诊断和有效治疗水平，可以防止并发症产生。     

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。     

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。     

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。     

The treatment of stricture of larynx and trachea with Ni-Ti shape memory alloy stand]

OBJECTIVE: To evaluate the use of Ni-Ti shape memory alloy stand in the treatment of stricture of larynx and trachea. METHODS: The clinical materials of 14 patients were analyzed. All patients had stricture of larynx and trachea and accepted the treatment with Ni-Ti shape memory alloy stand. RESULTS: All patients breathed freely after the operation, and the trachea fistula was closed at the time of operation. The follow-up survey for these patients lasted for 2 to 12 months. None of the patients had signs of the stricture of the respiratory tract. The short-term effective rate was 100%. CONCLUSION: Ni-Ti shape memory alloy stand can expand the stricture of larynx and trachea quickly and thus improve the breath effectively. It can be used as a routine method in the treatment of stricture of larynx and trachea.     

吸入性损伤患者气管切开的时机与指征

目的：探讨大面积烧伤伴吸人性损伤患者气管切开的时机与指征。方法与结果：烧伤后1～24h行气管切开术124例，死亡24例；24h后行气管切开术51例，死亡28例。气管切开时颈部有环状或半环状焦痂21例，伴头面部严重烧伤90例，烧伤后口唇黏膜水肿外翻似“鱼嘴状”32例，口鼻内大量血清样渗出37例。结论：大面积烧伤伴吸人性损伤时喉梗阻危象的发生是导致烧伤患者死亡的重要原因，强调在烧伤后早期及时进行气管切开术，可降低患者喉梗阻危象的发生率和死亡率。     

Stenosis of the larynx and trachea: diagnostics and treatment

36 cases (26 males and 10 females aged 19-69, average age 40.3) of larynx and trachea stenosis (23/36 i.e. 64%) and occlusion (13/36 i.e. 36%) were observed between 1990-1999. The cause of larynx and trachea lesion was the prolonged intubation in 17 (47%) cases, tracheostomy--in 13 (36%) (in 12 cases performed outside our centre), external trauma in 5 cases (14%) and burns of the upper airway in 1 patient (3%). For the diagnosis endoscopic, radiologic and spirometric examinations were performed. Length of the constricted or occluded section was estimated at 5-65 mm. Patients were treated applying three methods: endoscopy, splitting of the larynx and/or trachea and "end to end" anastomosis. In most cases surgical proceeding was multistaged. The best result was obtain after "end to end" anastomosis (all patients were deccanulated).     

Experience with the treatment of cicatrical laryngotracheal obstruction in children

A total of 152 children presenting with various forms of laryngotracheal obstruction were admitted to the Russian Children's Clinical Hospital during the period between 1995 and 2009. Cicatrical stenosis predominated in the structure of chronic laryngeal obstruction accounting for 33% of the cases. In the overwhelming majority of these patients, the main cause underlying the process of formation of rough cicatrical tissue in the larynx was a long-standing intubation injury (3-4 days during the inflammatory reaction and 7-8-day laryngeal intubation period). The patients with pronounced cicatrical obliteration of the larynx underwent laryngotracheal reconstruction of the laryngeal lumen with the formation of an external passage, removal the cicatrical conglomerate with the obligatory enlargement of the laryngeal cross section area in the stenosed region, and subsequent long-term prosthetic treatment with plastic closure of tracheostoma. Endoscopic microsurgery in the cicatrical stenosis region during direct laringoscopy under video control was used to treat the patients with superficial forms of cicatrical stenosis, such as membrane stenosis, synechiae, and circular stenosis, characterized by moderate narrowing of the laryngeal lumen.     

The causes of the development of cicatrical stenosis of the larynx and trachea in the patients presenting with Guillain-Barré syndrome

The problem of rehabilitation of the patients presenting with post-intubation stenosis of the larynx and trachea remains unresolved despite the development of new methods for the diagnostics and treatment of this condition. One of the indications for long-term artificial lung ventilation is the severe form of Guillaine-Barret syndrome associated with paralysis of breathing muscles, development of bulbar symptoms, and disturbances of trophic process in the skin and mucous membranes. However, prolonged (mean 26 days) artificial lung ventilation may result in the formation of many-layer stenosis of the larynx and trachea whereas disturbed trophic processes in the skin and mucous membranes coupled to inadequate innervation complicate the postoperative conditions of the patients and promote restenosis of the tracheal lumen.     

Cricotracheal resection for pediatric subglottic stenosis

Until recently, cricotracheal resection (CTR) has not been commonly accepted as a treatment modality for severe subglottic stenosis in the pediatric age group. The reasons have included the risk of a possible dehiscence at the site of the anastomosis, the likelihood of injury to the recurrent laryngeal nerves, and the interference with normal growth of the larynx. Thirty-eight infants and children with a severe subglottic stenosis underwent a partial cricoid resection with primary thyrotracheal anastomosis. Thirty-three patients were tracheotomy-dependent at the time of surgery and 34 were referred cases; 27 were classified as grade III, and 10 as grade IV stenoses according to new Cotton's classification. Nineteen patients were younger than 3 years of age at the time of surgery. The tracheotomy was resected during the surgical procedure in 21 cases. Decannulation was achieved in 36/38 cases after an open procedure. There is one complete restenosis and one good result awaiting decannulation after further surgery for a Pierre Robin syndrome. The authors experienced no lesion of the recurrent laryngeal nerves and no fatality. Thirty-one patients show no exertional dyspnea, three a slight stridor while exercising, and two patients are not decannulated. The postoperative follow-up in longer than 10 years in eight cases. All patients show a normal growth of the larynx and trachea. Compared to laryngotracheoplasties, CTR gives better results for severe subglottic stenosis. This operation should become the treatment of choice for severe (grade III and IV) subglottic stenosis in infants and children.