Modern management of laryngotracheal stenosis
Modern management of laryngotracheal stenosis
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DOI：
10.1097/01.mlg.0000228006.21941.12
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发表时间：
2006-09-01
期刊：
影响因子：
2.6
通讯作者：
Andersen, Peter E.
中科院分区：
文献类型：
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作者：
Herrington, Heather C.;Weber, Stephen M.;Andersen, Peter E.
目的：喉气管狭窄是一个复杂的问题，最常由插管、创伤或自身免疫性疾病引起。治疗选择包括扩张或气道重建，包括喉气管成形术 (LTP)、环气管切除术 (CTR) 和气管切除术 (TR)。我们描述了我们处理这个难题的经验。研究设计：对 1995 年 1 月至 2005 年 7 月期间在学术、三级转诊中心接受喉气管狭窄治疗的患者进行回顾性图表审查。方法：研究期间共有127名患者接受治疗。对患者进行随访，并审查医院记录。结果：男性38例，女性89例，平均年龄55.5岁，因插管导致的喉气管狭窄（64例）、特发性（25例）或自身免疫性疾病（18例）、放射（9例）、创伤（5例）、既往手术（4例）和复发性多软骨炎（2例）而接受治疗。 33% 的患者为 I 级狭窄，44% 为 II 级狭窄，19% 为 III 级狭窄，4% 为 IV 级狭窄。 70% 接受初始扩张的患者需要进行后续手术。分别有 43%、48%、71% 和 100% 的 I 级至 IV 级狭窄患者接受了 LTP、CTR 或 TR。在 76 名接受 LTP、CTR 或 TR 的患者中，24 名 (32%) 需要后续干预。在 36 名接受初次 LTP、CTR 或 TR 治疗的患者中，只有 10 名 (28%) 需要进一步治疗。 35 名依赖气管切开术的患者中有 22 名 (63%) 最终拔管。三名患者在术后立即死亡。结论：因喉气管狭窄而接受扩张的患者需要多次手术。然而，主要的重建手术耐受性良好，目前代表了喉气管狭窄的可行的主要治疗方法。
Objectives: Laryngotracheal stenosis is a complex problem resulting most often from intubation, trauma, or autoimmune disease. Management options include dilation or airway reconstruction including laryngotracheoplasty (LTP), cricotracheal resection (CTR), and tracheal resection (TR). We describe our experience with management of this difficult problem. Study Design: Retrospective chart review of patients treated for laryngotracheal stenosis between January 1995 and July 2005 at an academic, tertiary referral center. Methods: A total of 127 patients were treated during the study period. Patients were followed, and hospital records were reviewed. Results: There were 38 male and 89 female patients with an average age of 55.5 years treated for laryngotracheal stenosis resulting from intubation (64), idiopathic (25) or autoimmune disease (18), radiation (9), trauma (5), prior surgery (4), and relapsing polychondritis (2). Thirty-three percent were treated for grade I stenosis, 44% grade II, 19% grade III, and 4% grade IV. Seventy percent of patients undergoing initial dilation required a subsequent procedure. LTP, CTR, or TR was performed in 43%, 48%, 71%, and 100% of patients with grade I through IV stenosis, respectively. Among 76 patients undergoing LTP, CTR, or TR, 24 (32%) required a subsequent intervention. Among 36 patients treated with primary LTP, CTR, or TR, only 10 (28%) required further therapy. Twenty-two of 35 (63%) tracheostomy-dependent patients were ultimately decannulated. Three patients died in the immediate postoperative period. Conclusions: Patients undergoing dilation for laryngotracheal stenosis require multiple procedures. However, major reconstructive procedures are well tolerated and currently represent a viable primary treatment for laryngotracheal stenosis.