喉气管狭窄的支撑内固定疗效观察

对１２例喉气管狭窄病人行支撑固定治疗,手术时首先切除喉气管病变,松解瘢痕组织,局部修复后行扩张治疗,方法为：①用空心管做喉气管内固定扩张;②硅橡胶囊喉模软固定支撑;③“Ｔ”形管置入支撑。支撑扩张时间２周～１８个月。结果：９例顺利拔管;１例带管放疗１年后拔管;１例拔管后肿瘤复发改行半喉切除术;１例未支撑,带管随访中,认为喉气管狭窄行支撑内固定疗法,效果较满意。     

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 196 0年来经住院治疗的 33例喉气管创伤临床资料进行回顾性分析。创伤程度 型 12例 , 型 17例 , 型 4例 ,2 8例气管切开。闭合伤中应注意诊断。开放伤 、 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例咽瘘的产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。     

喉狭窄的治疗

喉狭窄在诊治方面虽已取得了长足的进步,但对于少数范围广泛的狭窄,切除后又不能直接吻合时往往需要多次手术,甚至仍不得不以永久气管造口来维持呼吸,使患者生活质量受到影响,这就要求我们耳鼻咽喉头颈外科医师进一步探索和寻求更好的治疗方法.本文对近几年来国内外在喉狭窄的病因、诊断、评估和治疗做一综述.     

声门下喉气管狭窄外科治疗

目的探讨复杂声门下喉及气管狭窄的外科治疗,提高喉气管狭窄的手术疗效。方法对20例因环状软骨和气管软骨环部分缺损或声门下瘢痕组织增生所致的声门下喉气管狭窄患者分别实施了胸骨舌骨肌蒂舌骨瓣(7例)、胸锁乳突肌锁骨骨膜瓣(12例)、游离皮片(1例)转移重建术,术后放置T型管。结果20例患者均于术后6个月顺利拔除T型管,恢复了较满意的呼吸和发音功能。结论胸骨舌骨肌蒂舌骨瓣、胸锁乳突肌锁骨骨膜瓣、游离皮片转移加T型管植入修复声门下喉气管狭窄的重建手术,具有较高的成功率和较好疗效。     

声带Reinke′s水肿的微创外科治疗

目的 :介绍微创外科治疗 Reinke′s水肿的经验。方法 :全麻显微支撑喉镜下 ,行双侧声带微创剥脱术 38例。结果 :经随诊 3个月～ 1年 ,2 7例获满意发音效果 ,只有 6例发音低沉。结论 :保留一侧声带前 1/ 2粘膜的双侧声带微创剥脱术 ,未发生声带粘连 ,值得提倡。     

丝裂霉素C治疗良性喉气管狭窄

良性喉气管狭窄多由长时间气管内插管、气管切开、炎症性疾病、化学灼伤、支架置入后的肉芽增生等原因引起,是一个非常棘手的临床问题。现有的治疗方法有电烧灼、激光、冷冻、微波或球囊扩张后置入支架等,但这些方法均有复发率高,需多次手术等弊端。部分临床医师尝试用丝裂霉素C作为辅助治疗,效果不一。本文对丝裂霉素C治疗良性喉狭窄和气管狭窄方面的文献进行综述,并简述近年来相关进展。     

喉部分切除术中喉功能修复术式的选择

目的 :探讨在治疗不同期喉癌喉部分切除术中不同的喉功能修复术式的疗效。方法 :对 30例 T2 ,部分 T3 声门型喉癌喉部分切除术后分别以胸骨舌骨肌 ,甲状软骨膜 ,颈前皮肤 ,Tucker's术修复喉功能。结果 :全部喉功能恢复占 83.3% (2 5/ 30 ) ,部分喉功能恢复 10 0 .0 %。结论 :对不同期喉癌喉部分切除后的功能修复术应采用不同的修复方法。病变范围越小 ,术后全部喉功能恢复率越高。喉部分切除时应作喉探查 ,以便彻底切除喉肿瘤的同时 ,选取最佳方案修复喉功能     

会厌下移一期重建声门治疗声门癌

本文报道用会厌下移一期重建声门术（Ｔｕｃｋｅｒ术）治疗双声带受侵犯的声门癌３１例，结果证明此手术不仅能彻底切除肿瘤，而且能有效的保存喉的发声、呼吸和吞咽保护功能，３年生存率８１．５％（２２／２７），降低了致残率及复发率，改善了患者的生存质量，故认为该术式是治疗双声带受侵的声门癌的一种较理想术式，值得推广使用。     

经鼻内镜筛窦径路治疗眶骨爆折的疗效观察

目的 :探讨筛窦径路经鼻内镜手术治疗眶骨爆折的临床疗效。方法 :总结 1998年 10月～ 2 0 0 1年 10月收治眶壁骨折患者 19例 ,均在鼻内镜下 ,行眶骨骨折整复术。结果 :经 6～ 12个月随访眶骨骨折 19例 ,术后复视消失 ,眼球凹陷改善。结论 :经鼻内镜筛窦径路手术治疗眶骨爆折 ,入路简捷 ,操作方便 ,眶内侵袭少 ,无面部疤痕 ,疗效可靠。     

喉次全切除双颈前皮瓣喉重建术临床应用研究

目的 :探讨喉次全切除双颈前皮瓣喉重建术临床应用的可行性、技术操作及疗效。方法 :选择 13例 T4喉鳞状细胞癌施行喉次全切除双颈前皮瓣喉重建术。结果 :本组病例术后发音成功率为10 0 % ,其中 11例言语可接受度达 7级 ,言语可理解度为 95 %以上 ,余 2例言语可接受度为 5级 ,言语可理解度为 90 %以上。误咽发生率为 15 .38%。本组 3年局部复发率为 15 .38% ,3、5年生存率分别为84.6 1%和 76 .92 %。结论 :该术式扩大了常规喉次全切除术的适应证 ,且有效地恢复喉的全部功能 ,并减轻致残程度 ,提高患者术后生存质量 ,值得推广应用     

Application of autocartilage for treatment of tracheostenosis with chondromalacia

Reconstruction of the stenotic part of the trachea with chondromalacia was made with semicircular autocartilage. The operation included two stages: creation of a semiring of rib autocartilage in abdominal tissues (stage I), implantation of the semiring to tracheal walls (stage II). Reception of the autocartilage was confirmed morphologically. According to 5 year follow-up, a stable positive result was obtained in 14 of 18 patients.     

喉部分切除术后并发喉狭窄的原因及处理

目的探讨喉癌行喉部分切除术后并发喉狭窄的原因及处理方法。方法回顾性分析2008-2013年住院治疗的28例喉癌术后并发喉狭窄的临床资料,28例患者根据引起狭窄的原因、狭窄的程度及狭窄的部位采取不同的治疗方式。其中2例术后联合放疗引起急性喉梗阻患者予以激素、抗感染治疗;16例患者行支撑喉镜下CO2激光切除术;5例患者行喉裂开术;5例患者行多次及多种联合手术。结果 28例患者中26例拔除气管导管,拔管率92.8%;2例患者手术后瘢痕及肉芽组织增生造成再次狭窄,随访至今仍未拔除气管导管。结论支撑喉镜下CO2激光切除术是喉癌行喉部分切除术后并发喉狭窄的首选方法,合理的修复缺损并喉腔重建、积极抗感染及治疗胃食管反流将会明显的减少喉部分切除术后喉狭窄的发生几率。     

Hyperbaric oxygenation in the postoperative treatment of children with cicatricial laryngostenosis

Hyperbaric oxygenation (HBO) was used in the combined treatment of 20 children, aged 2 to 14 years, after reconstructive surgery of the larynx. All the patients had been exposed to tracheostomy. As a result, optimal regimens of compression and decompression of operated children were developed which were 0.025 ata/min and 0.04 ata/min, respectively. HBO was most effective when whole-body and regional hypoxia was applied simultaneously. The optimal pressure in an altitude chamber was 0.9 to 1.0 ata for as long as 40 to 50 min. HBO made it possible to shorten the degenerative-inflammatory process. Positive changes in pH of the wound were regarded as an indication of reductive aerobic metabolism there.     

喉狭窄喉成形术经验(附77例报告)

本文介绍喉狭窄成形手术新经验：①不以扩张为主，而是按照创伤修复规律做喉成形手术，再造喉腔结构；②不同病因类型的喉狭窄采用不同类型成形术式来治疗；③尽量采用自体组织，坚持就近取材原则，创新术式。文章报告77例喉狭窄治疗效果，获成功拔管者74例（占96．1％）。     

外伤性喉狭窄的CO2激光治疗

利用CO2激光对24例外伤后喉狭窄的患者在全麻支撑喉镜下切除瘢痕组织,大部分(87.5%,21/24)患者术后呼吸困难及发音功能明显改善,随诊6个月至4年,疗效稳定.表明CO2激光是治疗外伤后喉狭窄的有效方法.     

Fistula between the trachea and innominate artery--a rare complication following tracheostenosis treatment with silastic tubes

BACKGROUND: Fistulas between the trachea and innominate artery are rare but devastating complications that usually occur following tracheotomies. METHODS: One case a fistula after long-term treatment of a tracheal stenosis with an Montgomery silastic tube was analyzed. A literature review of the different strategies in diagnosis and treatment of this complication was undertaken. RESULTS: In the present case, the fistula occurred after long-term treatment of tracheal stenosis with silastic tubes (Montgomery). Summarizing our experience with this case and a review of the literature, it can be concluded that: Fistulas most frequently occur following tracheostomy or tracheal reconstructive surgery. Frequent bronchoscopic examination during long-term treatment of tracheal stenosis with silastic tubes is essential. Even minor tracheal hemorrhage in such cases must be thoroughly examined. In case of fistula hemorrhage, the most effective treatment consists of direct local compression, best obtained with a well placed respiration tube. CONCLUSION: Fistulas between the trachea and innominate artery constitute a rare but possible complication after tracheal stenosis treatment.     

喉癌喉部分切除术后喉狭窄Ⅱ期喉重建术临床评价

目的使喉部分切除和扩大喉部分切除术后长期带管者去除气管套管,恢复喉的发音、呼吸、吞咽防护功能和正常颈部外观.方法对19例喉癌喉部分切除术后喉狭窄患者,应用颈前双蒂转门肌皮瓣等方法进行Ⅱ期喉重建术,其中包括垂直喉切除Ⅱ期喉重建术6例(6/19),扩大垂直喉切除术11例(11/19),额侧喉切除术2例(2/19).应用颈前双蒂转门肌皮瓣修复17例,胸骨舌骨肌瓣修复1例,胸锁乳突肌和筋膜修复1例.结果 3、5年生存率分别为91.7%(11/12)和3/5.19例中去除气管套管16例(其中包括2例行2次Ⅱ期喉重建术).总的气管套管拔出率为84.2%(16/19),应用转门肌皮瓣修复组拔管率为94.1%(16/17),胸骨舌骨肌瓣和胸锁乳突肌瓣修复组均未能拔管(0/2),拔管困难3例.术后全部患者能够发音,语言交流无困难.其中语音响亮清晰者为94.7%(18/19),重度声音嘶哑者为5.3%(1/19).全部患者恢复正常进食,绝大多数患者进食无误咽,2例初期进流食出现轻度误咽,1～2周误咽克服,恢复正常经口进食.结论中、晚期喉癌选择性地施行功能保全性喉手术是可行的;应用转门肌皮瓣进行Ⅱ期喉重建术,可使喉部分切除术后长期带管者去除气管套管,重新获得经口鼻呼吸和满意的发音、吞咽防护功能效果.     

支撑喉镜下治疗喉腔狭窄 (附7例报告)

目的探讨喉腔狭窄的微创治疗方法.方法回顾分析7例喉腔狭窄患者在支撑喉镜下治疗的临床资料.结果4例因喉癌术后喉功能不良者术后能顺利拔管;2例呼吸困难者,1例喉外伤患者呼吸困难术后均得到缓解.结论对于喉癌术后喉腔狭窄及喉支架完整的喉外伤后喉腔狭窄的患者,支撑喉镜下手术解除狭窄是一种创伤小、简单且有效的方法.     

Indicators of immunologic reactivity in children with chronic laryngostenosis

Immunological examinations of 40 children with papillomatosis and chronic cicatricial stenosis of the larynx included measurements of circulating immune complexes (CIC) and lysozyme in the saliva and serum as well as complement activity in serum. The examinations were performed regularly during treatment. It was found that immunobiological factors played an important part in the pathogenesis of papillomatosis and cicatricial stenosis of the larynx in children. It was shown that CIC and lysozyme concentrations in the saliva and serum as well as complement activity in serum increased. In the course of treatment all the groups displayed an increase of lysozyme in the saliva; patients with papillomatosis showed a decrease of the CIC concentration and those with cicatricial stenosis a decline of complement activity in serum. Involvement of the autoimmune component in the pathogenesis of the above diseases is discussed. Applicability of the results for controlling the therapeutic efficacy and predicting the outcome of diseases is considered.