喉全切除后气管造口植入式镍钛合金支架的研制和临床应用

目的 :研制喉全切除后气管造口植入式镍钛合金支架并临床应用 ,以期替代金属全喉套管预防术后气管造口狭窄。材料与方法 :直径为 0 .8mm的镍钛形状记忆合金钢丝 ,镍 5 0 %、钛 5 0 % ,支架形状为半圆形 (2 / 3)结构 ,其表面光滑 ,支架直径 18mm、19.5 mm、2 1mm三种规格。全喉切除 2 2例 ,选择大小合适的气管造口植入式镍钛合金支架 ,缝合固定于气管残段的第一和第二气管软骨环之间筋膜后 ,常规气管造口。术后气管造口敞开 ,免用金属全喉套管。结果 :术后造口 期愈合 19例 ;术后感染 3例。术后气管造口皮缘疤痕环形增生所至狭窄 6例 ,后经局麻下疤痕环切扩大造口治愈。术后无呼吸道症状 ,放疗后造口局部无组织坏死或感染。结论 :气管造口植入式镍钛合金支架临床应用安全、预防气管造口狭窄 ,可望替代金属全喉套管并预防气管造口狭窄。

A study on the production and the clinical application of Nickel|Titanium alloys stent implanted in tracheostome after total laryngectomy

Objective:In order to prevent tracheostomal stenosis (TSS) instead of laryngectomy cannulas after total laryngectomy, Nickel|Titanium shape memory alloys(NI|SMA) stents in tracheostome were produced and applicated in clinic. Methods: The diameter of NI-SMA is 0.8mm, and Ni 50%, Ti 50%. The shape of the Ni|SMA stent is the two|threeth of circumference and its diameters are 18mm, 19.5mm, 21mm. The stents were implanted between the first and the second tracheal cartilage ring of the stump in twenty|two patients with advanced laryngeal carcinoma or hypopharyngeal carcinoma or esophagul carcinoma in neck. All the patients were free of laryngectomy cannulas after operation. Results: Nieteen patients healed at one stage. Infections after operation were seen in three cases. Eight patients received radiotherapy after total laryngectomy. The NT|SMA stent did not influence radiotherapy after operation. The TSS occured in six of the patients. A simple procedure named “doughnut” for widening stenosis was performed successfully with an electric cautery knife in all the patients with tracheostomal stenosis after operation. Conclusions: The results suggested that the NT|SMA stents can prevent from traheostenosis instead of metal laryngectomy cannulas after total laryngectomy.