总气管再次狭窄患者T型管处理

目的:探讨再次气管狭窄患者的临床特点及T型管的应用价值。方法:对14例再次气管狭窄患者行气管造口下内镜和支撑喉镜进路,气管狭窄处理并用T型管置入,并留置6个月以上,随访患者1年以上,用电子喉镜评价患者气管狭窄康复情况。结果:气管狭窄的长度0.5mm至44mm,平均24mm,9例患者均为膜性狭窄。其中轻度狭窄5例,中度6例,重度狭窄3例。离气管隆突距离为4mm～54mm,平均26mm,其中6例均在距气管隆突20mm范围内,以气管插管病例为主。所有患者均未行狭窄段气管切除,均行狭窄段气管扩张或瘢痕切除,T管置入。平均带管时间为6.2月。拔出T管半年以上,所有患者气管腔内未见明显狭窄出现,1例残留有肉芽在原气管造口愈合处。结论:患者均需较长时间带管,需二次手术取出为其缺点,T管留置治疗再次气管狭窄失败率较低,疗效可靠。

Management of Total Tracheal Recurrent Stenosis by T-type Tube

Objective To detect the clinical feature of total tracheal recurrent stenosis and the value of T-type tube for the management.Methods 14 cases with recurrent total tracheal stenosis were treated with T-type tube by endoscopic via tracheostoma and pedestal laryngoscope approach.The period of maintain of tube in trachea was at least six months.The follow-up was performed for more than one year and the electronic laryngoscope was used to evaluate the rehabilitation of stegnosis.Results The longitude of stegnosis was from 0.5mm to 44 mm and the mean was 24mm.9 cases of them were only just membrane stegnosis.5 cases were belongs to slight stegnosis,6 midrange and 3 serious.The distance from the location of stegnosis to tracheal eminence was within 20 mm in six patients,who were mainly caused by tracheal intubation.All the 14 patients were not received the removal of stenotic portion of trachea and were managed with insertion of T-type tube after simply excision of stenosis or tracheaectasy.The mean period of maintaining T-type tube in trachea was 6.2 months.The stenosis was not been found in all recurrent cases after follow-up for six months after extraction of T-type tube.Only one had granulation on the cured tracheostoma but no stenosis-related symptom.Conclusion A long period of maintaining tube in trachea and the necessity to be taken it out was its shortcoming.Its preponderance included the less failure and good curative effects.