兔环状软骨裂开喉气管成形术对环状软骨生长发育的影响

目的：探讨兔环状软骨前后裂开对环状软骨生长发育的影响。方法：将兔环状软骨前后正中裂开,8个月后测量环状软骨内径,计算其管腔面积。结果：与对照组比较,实验组兔环状软骨管腔面积较对照组差异无统计学意义。结论：环状软骨裂开喉气管成形术对环状软骨的生长发育无显著影响。     

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。     

环状软骨前后裂开加移植物治疗严重声门及声门下狭窄

目的 总结采用环状软骨前后裂开加移植物治疗严重声门、声门下后壁狭窄经验。方法 回顾分析唐都医院近10年来治疗严重声门、声门下后壁狭窄患者25例，男15例，女10例。平均年龄31岁(9～46岁)。病程平均2年(3个月-6年)。19例曾采用各种喉成形术1—7次(平均2次)。全部病例术前均靠气管切开套管呼吸。手术采用喉气管裂开，环状软骨板正中裂开，加肋软骨(17例)；肌筋膜、软骨膜或裂层皮片(15例)；带蒂杓状软骨(2例)；甲状软骨块1例。T形管支撑3～6个月。结果 24例(96％)全部治愈拨管，恢复功能性发音。1例伤口感染，软骨坏死排出失败。随访1～10年，疗效可靠，未见再狭窄。结论 严重的声门及声门下后壁狭窄采用环状软骨前后裂开加移植物是比较安全有效的治疗方法。术中注意勿损伤食道壁，妥善止血，移植物缝合牢固，留置支撑器是成功的关键。     

环状软骨前后裂开加移植物治疗严重声门及声门下狭窄

目的　总结采用环状软骨前后裂开加移植物治疗严重声门、声门下后壁狭窄经验。方法　回顾分析唐都医院近 10年来治疗严重声门、声门下后壁狭窄患者 2 5例 ,男 15例 ,女 10例。平均年龄 31岁 (9～ 4 6岁 )。病程平均 2年 (3个月～ 6年 )。 19例曾采用各种喉成形术 1～ 7次 (平均2次 )。全部病例术前均靠气管切开套管呼吸。手术采用喉气管裂开 ,环状软骨板正中裂开 ,加肋软骨 (17例 ) ;肌筋膜、软骨膜或裂层皮片 (15例 ) ;带蒂杓状软骨 (2例 ) ;甲状软骨块 1例。T形管支撑3～ 6个月。结果　 2 4例 (96 % )全部治愈拔管 ,恢复功能性发音。 1例伤口感染 ,软骨坏死排出失败。随访 1～ 10年 ,疗效可靠 ,未见再狭窄。结论　严重的声门及声门下后壁狭窄采用环状软骨前后裂开加移植物是比较安全有效的治疗方法。术中注意勿损伤食道壁 ,妥善止血 ,移植物缝合牢固 ,留置支撑器是成功的关键     

儿童喉气管狭窄的治疗近况

一个世纪以来,喉气管狭窄的预防与治疗一直是摆在耳鼻咽喉一头颈外科医生面前的一道难题,由于儿童喉气管管腔狭小,且处在生长发育阶段,因此,在治疗上较成人更为困难。尽管目前试用了多种方法,但仍无一种共用方式可适用于所有类型的喉气管狭窄。目前治疗方法分外科和药物治疗两大类,其中外科治疗方法主要有喉气管功能重建和环状软骨切除术以及内镜激光手术等。     

环状软骨弓断裂后声门下区生长的组织学研究

环状软骨是气道支架中唯一完整的软骨环,通常认为它对气道管腔起着重要的支架作用,其弓部断裂会引起声门下区狭窄。然而过去对生长发育期家兔的形态学研究发现只要弓的内表层软组织不受损伤,声门下区的正常发育不会受影响。为了说明上皮下层组织在防止气道狭窄中的作用,作者进行了组织学研究。将新西兰种的雌性白兔分为7组。第1组为13只4周的幼兔,第2组为28只24周的成年兔,     

兔模型环气管切除术后气道形成及其在治疗儿童声门下狭窄的临床应用

虽然目前有许多治疗儿童声门下狭窄的方法，但疗效仍不理想，为了解决此难题，本文作者对兔行环气管部分切除术，并对术后气管管腔的大小，术后愈合情况，体重变化及喉气管吻合口形成情况进行观察，并与对照组及尸检小儿喉标本进行比较分析，得出以下结论：小于４岁的儿童声门下狭窄，通过行部分环状软骨气管切除来达到治疗目的，是安全和有效的。 本实验采用３９只８～１１周无巴斯德菌属的新西兰雌性白兔，分成实验组２９只，对照组１０只。实验组行部分环状软骨气管切除术。手术方法如下：上切口始于环甲膜中部，向外、后侧扩展，达环状…     

改良喉额侧部分切除喉功能重建术的实验研究

目的建立改良喉额侧部分切除喉功能重建术动物模型,验证其可行性。方法解剖离体组6只实验犬的喉体,对其原始声门面积、喉额侧部分切除后缝合甲状软骨切缘后的声门面积及在双侧切缘中间嵌入软骨条后（改良术式）的声门面积进行测量,比较各组数据之间的差异。在体组对10只实验犬分别行喉裂开右侧声带切除术、改良喉额侧部分切除喉功能重建术,测量并比较各组术后声门面积,10组（每组3名）志愿者对术后犬吠声进行评估。结果离体组：喉额侧部分切除后的声门面积19.48±7.89mm2,较原始声门面积（39.71±13.71mm2）明显缩小（t=5.74,P〈0.05）;改良喉额侧部分切除后的声门面积为49.90±12.25mm2,与原始声门面积比较差异无统计学意义（t=2.47,P〉0.05）。在体组：喉裂开右侧声带切除术后声门面积与术前比较差异无统计学意义（Q=0.047,P〉0.05）;改良喉额侧部分切除喉功能重建术后声门面积与术前比较差异无统计学意义（Q=8.74,P〉0.05）,与喉裂开右侧声带切除术后声门面积比较差异无统计学意义（Q=8.78,P〉0.05）;术后实验动物叫声仍可分辨。结论改良喉额侧部分切除喉功能重建术可有效保持喉腔正常大小,可用于喉狭窄等喉功能不良的整复。     

改良支撑管在喉外伤和喉气管狭窄中的应用

目的：探讨改良支撑管在喉外伤和喉气管狭窄中减少并发症及喉气管裂开次数的作用。方法：经各种不同方式行喉气管重建术，术中全部放入改良硅橡胶支撑管治疗急性严重喉气管外伤23例及慢性喉气管狭窄8例。结果：31例全部成功拔管，治愈率为100％。无呼吸道阻塞及严重误吸等并发症发生。6例第2次拔管者均是在第1次拔管时，同期经声门再次置入改良支撑管后治愈，避免了再次喉气管裂开术。结论：改良支撑管在预防和治疗喉气管狭窄中具有能保证呼吸道畅通，减少喉气管裂开术次数等优势。但拔管前不能发声是其缺点。     

环状软骨瘤1例报告并文献复习

目的 探讨环状软骨瘤的临床特征及处理方法.方法 回顾2020年1月3日贵州医科大学附属医院收治的环状软骨瘤1例患者的临床资料,并结合文献复习进行讨论.结果 经喉裂开使用耳科磨钻行环状软骨瘤切除并局部修复治疗,患者术后恢复良好并顺利拔除气管套管.随访3个月未见喉腔狭窄及复发.结论 环状软骨瘤是一种罕见的喉良性肿瘤,诊断上...     

Airway Growth After Cricotracheal Resection in a Rabbit Model and Clinical Application to the Treatment of Subglottic Stenosis in Children

Objective To evaluate the effects of a partial resection of the anterior cricoid arch on the growth of the laryngotracheal complex in an animal model and to study the lumen caliber and cross sectional surface area following resection as the animals are allowed to grow. Laryngeal, subglottic, and tracheal measurements in the infant and pediatric larynges in autopsy specimens are also investigated. Design A controlled animal study was done comparing the operated rabbit group to the nonoperated group. Twenty‐nine infant rabbits were compared to a control group of ten rabbits. In addition, autopsy dissections were performed on infant and pediatric larynges to obtain measurements of various laryngeal and cricoid relationships. Methods Thirty‐nine pasteurella‐free New Zealand white female rabbits between the ages of 8 and 11 weeks were used in this study. In the experimental group, cricotracheal resections were performed by removing the anterior cricoid cartilage and the first tracheal ring. A primary anastomosis was then performed. The animals were kept alive for 4 months and then humanely euthanized. The laryngeal complex was then removed and histological sections of the cricotracheal region were mounted on glass slides and stained with H&E. Measurements were taken of the cricoid and upper tracheal lumen and cross‐sectional area. Results Twenty‐seven of the study group survived until the time of sacrifice. All of the control group survived during the study period. The two groups were comparable in regard to weight, lumen size, and cross‐sectional area. There were no statistical differences between the groups. Conclusions The e‐perimental data support the hypothesis that partial cricotracheal resections can be performed safely and effectively in young rabbits. The potential clinical significance is described in light of the autopsy data.     

The anterior cricoid split in puppies

The acute and long-term effects of the anterior cricoid split on the subglottis of puppies intubated from 7 to 14 days are documented. The anterior cricoid split acutely increased the intralumenal cricoid surface area in puppies with intubation-induced airway injury. An intense inflammatory response with mucosal ulceration and granulation tissue is elicited by 14 days of intubation by using the canine model of induced subglottic stenosis developed by Supance et al. [19]. When animals intubated for 14 days underwent an anterior cricoid split on day 7, the airway appears essentially normal by day 14. The split cricoid cartilage maintained a 'U' configuration following the procedure. The region of deficient cartilage anteriorly is bridged by fibrous tissue with normal epithelium lining the lumenal surface. Splitting the cricoid cartilage anteriorly increased the intralumenal area and no long term complications resulted from the procedure. The mechanisms by which the anterior cricoid split expands the airway intralumenal area while maintaining airway support have been reviewed.     

A tissue-engineering technique for vascularized laryngotracheal reconstruction

OBJECTIVE: To perform laryngotracheal reconstruction (LTR) using a vascularized neotracheal segment. DESIGN: A neotracheal segment was created within the sternocleidomastoid muscle. An anterior cricoid split procedure was performed using a pedicled, vascularized neotracheal segment. Results were compared with a control group that underwent anterior cricoid split using standard (avascular) autografted cartilage. Cross-sectional area, cartilage viability, extrusion, mucosalization, and wound healing were compared between groups. SUBJECTS: Sixteen female New Zealand white rabbits. INTERVENTIONS: Eight animals underwent placement of a cartilage-wrapped silicone implant into the sternocleidomastoid muscle. After 2 weeks, the silicone implant was removed, leaving a fibrovascular "foreign body" capsule and the interwoven autografted cartilage. The neotracheal segment was trimmed to create an anterior graft for LTR. The remaining animals underwent standard anterior graft LTR using autografted auricular cartilage. The reconstructed segments were harvested for comparison at 2 and 4 weeks. RESULTS: All reconstructed animals survived the postoperative period. No significant differences in stenosis rates or mucosalization were noted between groups. Two animals in the standard LTR group had microabscess formation, and no graft extrusions were encountered. CONCLUSION: A pedicled neotracheal graft can be used for anterior cricoid split procedures in rabbits.     

Intrinsic and extrinsic forces determine the distortion of the split cricoid ring

OBJECTIVE: An anterior cricoid split (ACS) causes an immediate distortion of the cricoid cartilage resulting in an anterior gap due to retraction of the cut ends. The objective of this animal study is to investigate: (1) to what extent the distortion after ACS is influenced by non-cartilaginous structures like tunica elastica, membranes, ligaments and muscles, which are connected to the cricoid; (2) how distortion is changing with further development; (3) in what way the distortion is affected by scoring of the internal surface of the cricoid; and (4) whether an immediate or late injury-induced distortion is related to age. METHODS: Surgical interventions were performed in 20 young (8 weeks of age, 1300-1600 g) and 5 adult (28 weeks of age, 3500-4000 g) New Zealand White rabbits. The immediate effects were measured, and then the animals were followed for 20 weeks to study the long-term effects of the various procedures. RESULTS: (1) The gap, immediately following an ACS, increased after additional transection of the cricothyroid ligament and the cricotracheal membrane, and even more when the cricovocal membrane was elevated from the inner surface of the cricoid arch. (2) The degree of distortion after various interventions in young animals appeared to increase substantially during further growth. (3) When the above-mentioned successive surgical steps were combined with scoring of the internal surface of the cricoid arch, a marked malformation of the split cricoid did develop with warping of the cut ends in lateral direction and a latero-cephalic rotation, the latter due to the action of the cricothyroid muscles. (4) The immediate distortion appeared to be similar in young and adult animals. During a follow-up of 20 weeks, a progressive distortion of the split cricoid ring was observed in the young growing rabbits. In adult animals, no significant progression of the distortion was found. CONCLUSIONS: The immediate and long-term distortion of the split cricoid is determined by the release of intrinsic forces of the cartilage, and extrinsic forces from non-cartilaginous structures like ligaments, muscles, membranes and tunica elastica.     

Laryngotracheal stenosis repair using cartilage-derived morphogenic proteins: A pilot study

OBJECTIVES: This pilot study evaluated the role of cartilage-derived morphogenic proteins (CDMPs) as promoters of cartilage growth and differentiation and as a possible alternative to autologous cartilage grafts in laryngotracheal reconstruction. METHODS: In phase 1, 6 New Zealand rabbits underwent subperichondrial injection of CDMP-1, CDMP-2, or CDMP-3 in the right thyroid ala and normal saline solution in the left thyroid ala as controls. In phase 2, 14 rabbits underwent anterior cricoid split and interposition of a fibrillar collagen sponge saturated with normal saline solution, CDMP-2, or CDMP-3. RESULTS: In both phases, saline solution failed to induce new cartilage or bone growth. Small foci of cartilage and/or bone formation were observed within the thyroid subperichondria of those rabbits injected with CDMP-2 or CDMP-3. In phase 2, a few small foci of new cartilage and/or bone formation were observed at the edges of the cricoid split with CDMP-2 and CDMP-3. Conclusions: A different carrier of CDMP, a change in dosage, or a combination of CDMPs might yield more significant neochondrification. The role of CDMPs as promoters of cartilage and differentiation could not be disqualified in this study and should be further investigated.     

兔环状软骨损伤后软骨修复的实验研究

目的：探讨甲状软骨在环状软骨缺损修复中的作用。方法：将兔环状软骨前１／３切除,分别利用游离甲状软骨修复（游离组）和带蒂甲状软骨修复（带蒂组）,观察软骨的病理变化,结果：（１）游离软骨在２个月时坏死吸收,为瘢痕组织所取代,（２）带蒂软骨未见吸收 ,与环状软骨断端融合在一起。（３）环状软骨的发育未受影响。（４）气道通气不受影响。结论：游离软骨及带蒂软骨均能有效地修复环状软骨缺损。