Wax M K, Touma B J, Ramadan H H
Department of Otolaryngology-Head and Neck Surgery, Oregon Health Sciences University, Portland 97201, USA.
Laryngoscope. 1999 Sep;109(9):1397-401. doi: 10.1097/00005537-199909000-00006.
Tracheostomal stenosis following laryngectomy is a distressing complication with major effects on patient rehabilitation. Management ranges from stenting with a prosthetic device to surgical revision. The goal is a widely patent stoma that is amenable to tracheoesophageal puncture.
Review the long-term results of different methods of tracheostomal revision.
Review of 43 patients with symptomatic tracheostomal stenosis. End point was ability to function with no artificial stenting of their stoma.
Forty-three patients underwent 55 revisions. The male-to-female ratio was 1.3:1.0. The age range was from 38 to 81 years (mean age, 59.5 y). Median time to revision was 11 months following the initial surgical procedure (range, 1-150 mo). Thirty-three patients underwent one revision; eight patients, two revisions; and two patients, three revisions. In 40 of 43 patients (93%) revision was successful. Of the last 21 patients who underwent revision, 18 had tracheoesophageal punctures placed. Fifteen developed excellent tracheoesophageal speech. The initial rates of success for these procedures were as follows: advancement flaps, 8 of 9; Z-plasty, 13 of 15; V-Y inset, 8 of 8; other procedures, 2 of 4; and dilation, 2 of 7 (P < .05 for dilation vs. all others). The ultimate success rates for these procedures were as follows: advancement flaps, 8 of 11; Z-plasty, 15 of 18; V-Y inset, 12 of 13; other procedures, 3 of 6; and dilation, 2 of 7. Other procedures and dilation were inferior (P < .05) compared with advancement flap, Z-plasty, and V-Y insets.
Tracheostomal stenosis can be successfully managed in a multitude of ways.
喉切除术后气管造口狭窄是一种令人痛苦的并发症，对患者康复有重大影响。治疗方法包括使用假体装置进行支架置入到手术修复。目标是形成一个可广泛开放且适合进行气管食管穿刺的造口。
回顾不同气管造口修复方法的长期效果。
对43例有症状的气管造口狭窄患者进行回顾性研究。终点是造口无需人工支架即可正常功能的能力。
43例患者接受了55次修复手术。男女比例为1.3:1.0。年龄范围为38至81岁（平均年龄59.5岁）。初次手术后至修复的中位时间为11个月（范围1 - 150个月）。33例患者接受了一次修复；8例患者接受了两次修复；2例患者接受了三次修复。43例患者中有40例（93%）修复成功。在最后接受修复的21例患者中，18例进行了气管食管穿刺。15例患者形成了良好的气管食管语音。这些手术最初的成功率如下：推进皮瓣法，9例中的8例；Z成形术，15例中的13例；V - Y嵌入术，8例中的8例；其他手术，4例中的2例；扩张术，7例中的2例（扩张术与其他所有方法相比，P < 0.05）。这些手术最终的成功率如下：推进皮瓣法，11例中的8例；Z成形术，18例中的15例；V - Y嵌入术，13例中的12例；其他手术，6例中的3例；扩张术，7例中的2例。与推进皮瓣法、Z成形术和V - Y嵌入术相比，其他手术和扩张术效果较差（P < 0.05）。
气管造口狭窄可以通过多种方式成功治疗。
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