气管狭窄段切除术联合气道介入治疗创伤性气管狭窄的效果

发布时间：2018-03-07 13:54

本文选题：良性气管狭窄　切入点：外科切除　出处：《广东医学》2017年S1期 　论文类型：期刊论文

【摘要】：目的探讨气管狭窄段切除断端吻合术联合气道介入治疗创伤性气管狭窄的疗效及安全性。方法回顾17例因气管插管或气管切开后创伤性气管狭窄的患者,经气管狭窄段切除断端吻合术后随访,采用支气管镜和(或)螺旋CT三维重建对气管狭窄的位置、范围及局部炎性、水肿等情况进行评估,并记录术后再狭窄的发生率及气道介入治疗的处理和预后。结果 17例难治性创伤性气管狭窄患者中,男14例,女3例,年龄17~72岁,中位年龄47岁,气管插管后狭窄8例,气管切开后狭窄9例,狭窄段平均长度(2.4±1.2)cm,平均气道内径(4.6±1.7)mm。按狭窄类型分型:肉芽增生性狭窄9例,瘢痕性狭窄7例,动力性狭窄1例;按治疗方式分型:难治性气管狭窄12例(经3次气道介入治疗无效),复杂性气管狭窄5例(需直接选择手术治疗)。所有患者经狭窄段切除断端吻合术后未发现吻合口瘘或气管断裂等严重围手术期并发症。13例患者治疗后症状明显缓解,平均气道内径增加至(12.6±1.8)mm;术后发生再狭窄4例,均为单纯性肉芽组织增生性狭窄,其中2例需置入气道支架治疗。4例患者平均经介入治疗3次后病情稳定,随访1年均无再狭窄发生。结论气管狭窄段切除断端吻合术治疗良性创伤性气管狭窄的疗效良好,少数患者术后出现吻合口再狭窄,因再狭窄类型为单纯性肉芽增生性狭窄,联合气道介入技术治疗可获得满意效果。难治性或复杂性创伤性气管狭窄应及早行气管狭窄段切除术联合气道介入治疗,此联合治疗方法可缩短治疗疗程,提高远期疗效。
[Abstract]:Objective to investigate the tracheal stenosis resection and end-to-end anastomosis of traumatic tracheal airway combined with the efficacy and safety of interventional therapy for stenosis. Methods 17 cases of patients with traumatic tracheal stenosis after tracheal intubation or incision of trachea, trachea stenosis resection and anastomosis were used after bronchoscopy and (or) on a narrow spiral CT 3D reconstruction the trachea, and local inflammatory edema, evaluate, and record the treatment and prognosis of postoperative restenosis rate and airway interventional therapy. Results 17 cases of refractory traumatic tracheal stenosis patients, male 14 cases, female 3 cases, age 17~72 years old, the median age was 47 years old, trachea after intubation after tracheotomy stenosis in 8 cases, 9 cases of stenosis, stenosis of the average length (2.4 + 1.2) cm, the mean airway diameter (4.6 + 1.7) mm. according to the narrow type: granulation hyperplasia of cicatricial stenosis in 9 cases, 7 cases of narrow, dynamic stenosis in 1 cases; According to the treatment of refractory type: 12 patients with tracheal stenosis (after 3 times of interventional treatment of airway is invalid), the complexity of 5 patients with tracheal stenosis (need to direct surgical treatment). All the patients underwent end-to-end anastomosis after resection of stenotic segments found no anastomotic fistula or tracheal fracture and other serious perioperative complications in.13 patients after the symptoms, the average airway diameter increased to (12.6 + 1.8) mm; restenosis after 4 cases were simple hyperplasia of granulation tissue stenosis, including 2 cases of airway stent for treatment of.4 patients with an average of 3 times of interventional therapy in stable condition after 1 year follow-up, no restenosis. Conclusion tracheal stenosis segment resection and anastomosis curative effect in the treatment of benign stricture of traumatic tracheal is good, a small number of patients with postoperative anastomotic stenosis, restenosis due to type of simple hyperplasia of granulation tissue stenosis, interventional technique can obtain treatment combined with airway Satisfactory. Refractory or complicated traumatic tracheal stenosis should be early tracheal stenosis resection combined with airway intervention, this combined treatment can shorten the course of treatment, improve the curative effect.

【作者单位】：广州呼吸疾病研究所;
【基金】：广东省科技计划项目(编号:2013B021800318) 卫生公益性行业科研专项项目(编号:201402024)
【分类号】：R653

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