Maddaus M A, Toth J L, Gullane P J, Pearson F G
Division of Thoracic Surgery, Toronto General Hospital, Ontario, Canada.
J Thorac Cardiovasc Surg. 1992 Nov;104(5):1443-50.
Postintubation injury of the upper airway commonly results in stenotic lesions of the larynx, subglottis, and adjacent trachea. The traditional approach to surgical correction is laryngofissure for the laryngeal component and staged plastic reconstruction of the subglottic stenosis. Reported results are variable and unpredictable, and permanent extubation is impossible in a significant number of patients. We report experience with 15 patients with combined laryngeal, subglottic, and tracheal stenosis who were managed by a one-stage operation: circumferential resection of the subglottis and trachea with primary thyrotracheal anastomosis, combined with laryngofissure and laryngeal reconstruction. These procedures required the collaboration of the Departments of Otolaryngology and Thoracic Surgery of the Toronto General Hospital. Between 1972 and 1991, our thoracic surgical division did 53 circumferential subglottic tracheal resections with primary thyrotracheal anastomosis for benign disease. There were no operative deaths and 51 of 53 patients were successfully extubated. In 15 of these patients, a concomitant laryngofissure for laryngeal reconstruction was required. Laryngeal repair included excision or incision of interarytenoid scar (n = 13), interarytenoid mucosal graft (n = 6), or mobilization of cricoarytenoid joint (n = 3). A temporary laryngotracheal stent (usually a Montgomery T tube) was maintained after the operation in all cases (duration 3 to 42 months). Thirteen of these 15 patients are now permanently extubated and none has functionally significant restenosis. Vocal function is satisfactory to good in these patients. The approach described for these combined laryngotracheal lesions provides better results than those reported with traditional staged and plastic techniques of reconstruction. The collaboration of the departments of otolaryngology and thoracic surgery was essential to achieve these results.
气管插管后上气道损伤通常会导致喉、声门下及相邻气管的狭窄性病变。传统的手术矫正方法是针对喉部病变进行喉裂开术，并对声门下狭窄进行分期整形重建。报道的结果参差不齐且难以预测，相当一部分患者无法实现永久拔管。我们报告了15例合并喉、声门下及气管狭窄患者接受一期手术治疗的经验：声门下和气管的环形切除并一期甲状气管吻合术，同时联合喉裂开术和喉部重建。这些手术需要多伦多总医院耳鼻喉科和胸外科的协作。1972年至1991年期间，我们胸外科对53例良性疾病患者进行了声门下气管环形切除并一期甲状气管吻合术。无手术死亡病例，53例患者中有51例成功拔管。其中15例患者需要同时进行喉裂开术以进行喉部重建。喉部修复包括切除或切开杓间瘢痕（n = 13）、杓间黏膜移植（n = 6）或环杓关节活动（n = 3）。所有病例术后均留置临时喉气管支架（通常为蒙哥马利T形管）（持续时间3至42个月）。这15例患者中有13例现已永久拔管，且无一例出现功能性明显的再狭窄。这些患者的嗓音功能令人满意或良好。所述的针对这些联合喉气管病变的治疗方法比传统的分期整形重建技术所报道的结果更好。耳鼻喉科和胸外科的协作对于取得这些结果至关重要。
