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。

Causes and treatment of laryngostenosis after partial laryngectomy in patients with laryngeal carcinoma

Objective To investigate the causes and treatment of laryngostenosis after partial laryngectomy in patients with laryngeal carcinoma. Methods Clinical data of 28 patients hospitalized in our department from 2008 to 2013 due to laryngostenosis after partial laryngectomy was analyzed retrospectively. To all the 28 patients, appropriate treatment strategies were adopted according to the cause, degree and site of stenosis. Hormonotherapy and anti- infective treatment were applied to 2 cases with acute laryngeal obstruction due to radiotherapy, CO2 laser resection under self-retaining laryngoscope to 16, laryngofissure to 5, and multiple combined surgeries to 5. Results Of all the 28 cases, 26 were decannulated successfully with a deeannulation rate of 92.8%. Uptill now, decannulation has not been achieved in 2 patients due to restenosis caused by scar and granulation tissue. Conclusion Endoscopic CO2 laser resection is the preferred method for laryngeal stenosis after partial laryngectomy in patients with laryngeal carcinoma. Reasonable reconstruction of larynx, anti-infection and treatment of gastroesophageal reflux can significantly reduce the incidence of recurrent laryngeal stenosis after partial laryngectomy.