Nouraei S A Reza, Ghufoor Khalid, Patel Anil, Ferguson Tina, Howard David J, Sandhu Guri S
Department of Otolaryngology, Charing Cross Hospital, London, UK.
Laryngoscope. 2007 Jun;117(6):1073-9. doi: 10.1097/MLG.0b013e318050ca12.
OBJECTIVES/HYPOTHESIS: To assess the results of primary endoscopic treatment of adult postintubation tracheal stenosis, to identify predictors of a successful outcome, and better define the scope and limitations of minimally-invasive surgery for this condition.
Sixty-two consecutive patients treated between April 2003 and 2006 with initial endoscopic surgery were prospectively studied. Patient and lesion characteristics, treatment details, complications, decannulation, and open surgery rates were recorded. Actuarial analysis and Cox regression were used to identify predictors of decannulation and freedom from external surgery.
There were 34 male patients and the average age was 45 +/- 16 years. The average stenosis height was 18 mm (range: 5-55 mm), and 82% of lesions were Myer-Cotton grades III or IV. Lesion height and intubation-to-treatment latency independently predicted success of endoscopic surgery. Ninety-six percent of patients with lesions <30 mm in height were treated endoscopically, but the success rate fell to 20% for lesions longer than 30 mm. Patients with recalcitrant lesions underwent airway augmentation (n = 11) or resection (n = 3), with a 79% success rate. All patients were decannulated, but some, predominantly morbidly obese patients, required long-term stents for dynamic airway compromise. Ninety-eight percent of re-interventions occurred within 6 months.
Minimally invasive treatment is effective in postintubation airway stenosis and obviates the need for open cervicomediastinal surgery in most patients. Patients with old and long lesions are less likely to be cured endoscopically. For most patients in this subgroup, endoscopic surgery makes airway augmentation a viable, less invasive alternative to resection. Patients were unlikely to require further therapy after 6 months of symptom-free follow-up.
目的/假设：评估成人插管后气管狭窄的初次内镜治疗结果，确定成功治疗的预测因素，并更好地界定针对该病症的微创手术的范围和局限性。
对2003年4月至2006年期间连续接受初次内镜手术治疗的62例患者进行前瞻性研究。记录患者和病变特征、治疗细节、并发症、拔管情况及开放手术率。采用精算分析和Cox回归分析来确定拔管及避免接受外部手术的预测因素。
男性患者34例，平均年龄45±16岁。平均狭窄高度为18毫米（范围：5 - 55毫米），82%的病变为迈尔 - 科顿分级III级或IV级。病变高度和插管至治疗的时间间隔可独立预测内镜手术的成功。高度小于30毫米的病变患者中，96%接受了内镜治疗，但病变长度超过30毫米的患者成功率降至20%。顽固性病变患者接受了气道扩张术（n = 11）或切除术（n = 3），成功率为79%。所有患者均成功拔管，但部分患者，主要是病态肥胖患者，因动态气道受压需要长期置入支架。98%的再次干预发生在6个月内。
微创治疗对插管后气道狭窄有效，多数患者无需进行开放的颈纵隔手术。病变陈旧且较长的患者内镜治疗治愈的可能性较小。对于该亚组中的大多数患者而言，内镜手术使气道扩张成为一种可行的、侵入性较小的替代切除术的方法。在无症状随访6个月后，患者不太可能需要进一步治疗。
