喉气管狭窄手术治疗分析

发布时间：2018-04-09 15:58

本文选题：喉气管狭窄　切入点：瘢痕　出处：《重庆医科大学》2017年硕士论文

【摘要】：目的探讨喉气管狭窄的手术治疗方式和疗效。方法回顾性分析2011年~2015年我科收治的48例喉气管狭窄患者的临床资料,其中6例拒绝手术,42例纳入随访分析。23例给予支撑喉镜下CO2激光瘢痕切除术(其中2例术中给予平阳霉素注射),10例给予喉气管成形+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+T管植入术。观察患者的手术次数、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例病人共67次手术,激光手术35次,喉气管成形+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+T管植入术7次。1次性手术治愈的有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。手术效果理想有24例,基本理想有10例,无效8例,手术成功率为80.95%。24例术中置管,18例最终拔管,拔管率为75%。术后38例患者有不同程度的声嘶,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,狭窄平面多少,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,降低复发率。
[Abstract]:Objective to investigate the surgical treatment and curative effect of laryngotracheal stenosis.Methods the clinical data of 48 patients with laryngotracheal stenosis from 2011 to 2015 were retrospectively analyzed.Among them, 6 cases refused surgery and 42 cases were included in follow-up analysis. 23 cases received CO2 laser scar resection under laryngoscope (2 cases received pingyangmycin injection and 10 cases received laryngotracheoplasty T-tube implantation and 2 cases received breast locking milk).T-tube reconstruction with clavicular periosteum flap was performed in 7 cases with end-to-end end-to-end anastomosis of trachea.The times of operation, the time of extubation, the swallowing and eating after operation, the activity tolerance were observed, and the curative effect of the operation was evaluated.Results there were 67 operations in 42 patients, 35 laser surgery, 18 tracheoplasty T tube implantation, 7 reconstruction T tube implantation with sternocleidomastoid clavicle periosteum flap.24 cases were cured by 7 times of T tube implantation with end-to-end anastomosis of trachea cuff, 3 cases underwent 3 operations and 5 cases underwent 4 times operation, 1 case had 5 operations, 1 case had 6 cases with long term tube and 2 cases died.The result of operation was ideal in 24 cases, basic ideal in 10 cases, ineffective in 8 cases. The successful rate of operation was 80.95%. 18 cases had final extubation, and the extubation rate was 7595%.After operation, 38 patients had different degrees of hoarseness, all patients had no dysphagia, and 3 patients with drinking water choking cough had decreased activity tolerance.Conclusion preoperative evaluation of the patient's condition, according to the degree of stenosis, location, length, the size of the stenosis plane, the patient's physical condition and whether the constitution of the scar, the best operation to reduce the number of operations, at the same time,Appropriate adjuvant drugs can also be given after the operation to reduce the recurrence rate.
【学位授予单位】：重庆医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R767.91

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