Liu Y-H, Wu Y-C, Hsieh M-J, Chao Y-K, Wang C-J, Ko P-J, Liu H-P
Division of Thoracic and Cardiovascular Surgery, Chang Gung Memorial Hospital, Chang Gung University, Gueishan Shiang, Taoyuan, Taiwan, Republic of China.
J Laryngol Otol. 2009 Jul;123(7):772-7. doi: 10.1017/S0022215108004052. Epub 2008 Nov 3.
We evaluated the efficacy and safety of the extra-long Montgomery T tube for the management of major airway obstruction in tertiary care patients in Taiwan.
Eleven patients with major airway stenosis treated with an extra-long Montgomery T tube between April 2004 and December 2006 were retrospectively reviewed. Five patients had tracheostomy stenosis, two had intubation stenosis, one had traumatic stenosis, one had corrosive stenosis, one had laser burn stenosis and one had tubercular stenosis. All patients underwent three-dimensional airway reconstruction and endoscopic evaluation of airway stenosis. After determining the severity and location of airway stenosis, rigid bronchotherapy and Montgomery T tube placement were performed by rigid bronchoscopy.
The overall procedural success rate was 100 per cent. Three (27 per cent) patients were weaned from artificial ventilation, and all patients exhibited improved respiratory and functional status. No major post-operative complications or mortality were observed. At follow up (mean, 21.5 months), the decannulation rate was 27 per cent, and eight (73 per cent) patients had stable T tube ventilation. In four patients, granulation over the end of the T tube was controlled by endoscopic procedures. Three patients with stents above the vocal folds showed aspiration and required further intervention (i.e. one nasogastric feeding tube for nutrient supplement, one feeding jejunostomy and one stent shortening to decrease aspiration).
The extra-long Montgomery T tube is an effective and safe method for treating major airway obstruction in the supra-glottic to lower tracheal region.
我们评估了超长蒙哥马利T型管对台湾三级护理患者大气道梗阻的治疗效果及安全性。
回顾性分析了2004年4月至2006年12月间11例接受超长蒙哥马利T型管治疗的大气道狭窄患者。其中5例为气管造口狭窄，2例为插管后狭窄，1例为创伤性狭窄，1例为腐蚀性狭窄，1例为激光灼伤性狭窄，1例为结核性狭窄。所有患者均接受了气道三维重建及气道狭窄的内镜评估。在确定气道狭窄的严重程度和位置后，通过硬质支气管镜进行硬质支气管治疗及蒙哥马利T型管置入。
总体手术成功率为100%。3例（27%）患者成功脱机，所有患者的呼吸及功能状态均有所改善。未观察到重大术后并发症或死亡病例。随访（平均21.5个月）时，拔管率为27%，8例（73%）患者T型管通气稳定。4例患者T型管末端肉芽组织通过内镜操作得到控制。3例声门以上置入支架的患者出现误吸，需要进一步干预（即1例经鼻胃管补充营养，1例空肠造瘘管饲，1例缩短支架以减少误吸）。
超长蒙哥马利T型管是治疗声门上至气管下段大气道梗阻的一种有效且安全的方法。
