42例喉气管狭窄手术治疗分析

目的探讨气管狭窄不同部位、长度、程度及不同狭窄平面最佳手术方式的选择及其疗效。方法回顾性分析2011~2015年我科收治的42例喉气管狭窄患者的临床资料。42例患者中，23例给予支撑喉镜下CO2激光瘢痕切除术，10例给予喉裂开瘢痕切除+T管植入术，2例给予胸锁乳突肌锁骨骨膜瓣喉气管腔重建+T管植入术，7例给予气管袖状切除+端端吻合术。所有患者随访1~6年，观察记录患者的手术次数、拔管时间、术后吞咽进食、活动耐量情况，评估手术疗效。结果42例患者共67次手术，其中激光手术35次，喉裂开瘢痕切除+T管植入术18次，胸锁乳突肌锁骨骨膜瓣喉气管腔重建+T管植入术7次，气管袖状切除+端端吻合术7次。1次性手术治愈24例，2次手术3例，3次手术5例，4次手术1例，5次手术1例，6例长期带管，2例死亡。手术效果理想患者24例，基本理想患者10例，无效8例，手术成功率为80.95%。18例术中置管，12例最终拔管，拔管率为66.7%。术后38例患者伴不同程度的声嘶，所有患者无吞咽困难、饮水呛咳，3例患者出现活动耐量下降。结论术前要对患者病情充分评估，根据狭窄程度、部位、长度，狭窄平面大小，患者身体状况以及是否为瘢痕体质等选择最佳的手术方式，减少手术次数，同时，术后还可以给予适当的辅助性药物治疗，降低复发率。

Surgical treatment of laryngotracheal stenosis in 42 cases

Abstract:ObjectiveTo explore the optimal surgical method and analyze its curative effect for tracheal stenosis with different stenotic position, length, degree and plane.MethodsClinical data of 42 patients suffering from laryngotracheal stenosis surgically treated in our department between 2011 and 2015 were analyzed retrospectively. Of them, 23 cases underwent scar excision by CO2 laser under self restaining laryngoscope, 10 received scar excision combined with T tube placement via laryngofissure, 2 were given laryngotracheal reconstruction with sternocleidomastoid myoperiosteal flap and T tube placement, and 7 were treated with end to end tracheal anastomosis after sleeve resection. All patients had been followed up for 1 to 6 years postoperatively. Clinical data including the number of operations, duration of T tube placement, function of swallowing and feeding as well as exercise capacity were recorded and analyzed to evaluate the therapeutic effect.ResultsA total of 67 operations were performed to the 42 patients, including 35 CO2 laser excisions, 18 scar excisions combined with T tube placement via laryngofissure, and 7 laryngotracheal reconstructions with sternocleidomastoid myoperiosteal flap and T tube placement, as well as 7 end to end tracheal anastomoses after sleeve resection. 24 cases were cured after single operation, 3 cases after 2 operations, 5 cases after 3 operations, 1 case after four operations and 1 case after five operations, while 6 cases respired depending on T tube permanently and 2 cases died. The success ratio of operation was 80.95%, and the decannulation rate was 66.7%. In addition, hoarseness presented in 38 cases and the exercise capacity decreased in 3.ConclusionsLaryngotracheal stenosis requires individual precise preoperative assessments of stenotic position, length, degree and plane, as well as physical condition of the patient to select the optimal surgical method. Meanwhile, proper adjuvant medical treatment should be supplied for reducing recurrence.