Gaafar A A, El-Daly A A, Gaafar H A
Department of Otolaryngology Head & Neck Surgery, University of Alexandria, Egypt.
J Laryngol Otol. 2008 Apr;122(4):391-6. doi: 10.1017/S0022215107008109. Epub 2007 May 14.
The management of laryngotracheal stenosis is still a serious surgical challenge. The fact that there are currently numerous reconstruction procedures indicates that there is at present no standard treatment.
Titanium mesh was used instead of traditional homografts in reconstruction of the anterior laryngotracheal wall in 12 tracheostomised patients with benign chronic laryngotracheal stenosis. The anterior laryngotracheal wall was split, followed by excision of scar tissue and fixation of the titanium plate at the split end. A Silastic stent was inserted above the tracheostomy tube and fixed in place by running sutures fixed to the skin by buttons. The stent was removed endoscopically six weeks later and a trial of decannulation was undertaken.
Endoscopically, good epithelisation was seen on the inner surface of the mesh in 10 cases and decannulation was possible. Four of these patients required endoscopic debulking of granulation tissue. Decannulation was impossible in two cases, one due to excessive granulation tissue and the other due to prolapse of the titanium mesh into the tracheal lumen (the mesh was removed endoscopically and a Montgomery T-tube inserted).
Titanium mesh was found to be a good alternative for augmentation of the anterior laryngotracheal wall. It offered rigid support, with fewer of the complications reported with other grafts.
喉气管狭窄的治疗仍是一项严峻的外科挑战。目前存在众多重建手术这一事实表明，目前尚无标准治疗方法。
在12例患有良性慢性喉气管狭窄且已行气管切开术的患者中，使用钛网替代传统同种移植物重建喉气管前壁。切开喉气管前壁，随后切除瘢痕组织，并将钛板固定于切开端。在气管造口管上方插入一个硅橡胶支架，通过缝线固定于皮肤上的纽扣将其固定在位。六周后通过内镜取出支架，并尝试拔管。
在内镜检查中，10例患者的钛网内表面可见良好的上皮化，且可以拔管。其中4例患者需要通过内镜切除肉芽组织。2例患者无法拔管，1例是由于肉芽组织过多，另1例是由于钛网脱垂至气管腔内（通过内镜取出钛网并插入一个蒙哥马利T形管）。
发现钛网是增强喉气管前壁的良好替代物。它提供了坚固的支撑，且与其他移植物相比并发症更少。
