On the development of idiopathic subglottic stenosis
On the development of idiopathic subglottic stenosis
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DOI：
10.1016/j.mehy.2007.12.017
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发表时间：
2008-01-01
影响因子：
4.7
通讯作者：
Damrose, Edward J.
中科院分区：
文献类型：
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作者：
Damrose, Edward J.
特发性声门下狭窄是指环状软骨水平的气道纤维性狭窄，可导致严重的呼吸困难。女性占压倒性优势，治疗通常包括扩张、气管切开术或切除受累部分的呼吸道。确切的作用机制尚不清楚。雌激素一直被认为在这种疾病的发病机制中发挥了作用，但在从患者身上提取的组织样本中尚未发现雌激素受体。仔细观察病人的病史，通常会发现在出现症状之前有严重的咳嗽发作，术中检查可发现环状软骨腔内第一个气管环嵌塞。基于这些观察，我们推测第一气管的间歇性伸缩效应。环状软骨腔内的环状结构可导致局部血液供应中断，损伤环状软骨粘膜，导致粘膜水肿、缺血，最终导致纤维化。白色雌激素已被证明在创面加热中起到有益的作用，异常的创面加热可能因雌激素受体表达的变化而增强，也可以解释这种疾病中女性占优势的原因。(C)2008爱思唯尔有限公司。保留所有权利。
Idiopathic subglottic stenosis is a fibrotic narrowing of the airway at the Level of the cricoid cartilage, which can result in severe dyspnea. There is an overwhelming female preponderance, and treatment usually involves dilation, tracheostomy or resection with reconstruction of the involved portion of the airway. The exact mechanism of action is unknown. Estrogen has been thought to play a role in the pathogenesis of this disease, but estrogen receptors have not been found in tissue specimens taken from afflicted individuals. A careful history taken from the patient often reveals a severe episode of coughing prior to the development of symptoms, and intraoperative examination can reveal impaction of the first tracheal ring within the lumen of the cricoid cartilage. Based on these observations, we surmise that an intermittent telescoping effect of the first tracheal. ring within the lumen of the cricoid cartilage can lead to disruption of the local blood supply and trauma to the cricoid mucosa, with consequent mucosal edema, ischemia, and ultimately fibrosis. White estrogen has been shown to play a beneficial rote in wound heating, abnormal wound heating may be potentiated by variations in estrogen receptor expression, and could also explain the female preponderance seen in this disease. (c) 2008 Elsevier Ltd. All rights reserved.