Lebovics R S, Hoffman G S, Leavitt R Y, Kerr G S, Travis W D, Kammerer W, Hallahan C, Rottem M, Fauci A S
National Institute on Deafness and other Communication Disorders, National Institutes of Health, Bethesda, MD 20892.
Laryngoscope. 1992 Dec;102(12 Pt 1):1341-5. doi: 10.1288/00005537-199212000-00005.
Wegener's granulomatosis (WG) is a multisystem inflammatory disease characterized by vasculitis, granuloma formation, and necrosis. Among 158 patients treated at the National Institutes of Health during the past 24 years, 145 (92%) had an otolaryngologic manifestation of their disease and 25 (16%) had subglottic stenosis (SGS). SGS varied from asymptomatic to life-threatening. Sixteen (80%) of 20 patients with fixed SGS required surgical intervention, including manual dilations, carbon-dioxide laser resections, and laryngotracheoplasty (LTP). LTP was performed with and without microvascular reconstruction. Thirteen of the patients required tracheostomy and all 13 were ultimately decannulated. Five patients who repeatedly failed dilations and/or endoscopic laser surgery underwent LTP. Since 1987, two patients have undergone LTP with microvascular free flaps. Both patients were subsequently decannulated. The authors' experience demonstrates that management of SGS in WG is complex, requiring individualized frequent multimodality interventions to achieve satisfactory results. Microvascular laryngotracheal reconstruction should be considered in the surgical armamentarium for patients with persistent stenoses.
韦格纳肉芽肿（WG）是一种多系统炎症性疾病，其特征为血管炎、肉芽肿形成和坏死。在过去24年里，美国国立卫生研究院治疗的158例患者中，145例（92%）有耳部或喉部疾病表现，25例（16%）有声门下狭窄（SGS）。SGS症状从无症状到危及生命不等。20例固定性SGS患者中有16例（80%）需要手术干预，包括手动扩张、二氧化碳激光切除和喉气管成形术（LTP）。LTP手术有微血管重建和无微血管重建两种方式。13例患者需要气管切开术，最终全部拔管。5例反复扩张和/或内镜激光手术失败的患者接受了LTP。自1987年以来，2例患者接受了带微血管游离皮瓣的LTP。这2例患者随后均拔管。作者的经验表明，WG中SGS的治疗很复杂，需要个体化的频繁多模式干预才能取得满意效果。对于持续性狭窄患者，手术方案中应考虑微血管喉气管重建。
