Suzuki Masami, Tsunoda Atsunobu, Shirakura Satoshi, Sumi Takuro, Nishijima Wataru, Kishimoto Seiji
Department of Head & Neck Surgery, Gunma Prefectural Cancer Center, Japan.
Auris Nasus Larynx. 2010 Aug;37(4):465-8. doi: 10.1016/j.anl.2009.11.007. Epub 2009 Dec 29.
Stenosis of a permanent tracheostoma after total laryngectomy lowers postoperative quality of life (QOL), and its prevention is clinically important.
From April 2003 to March 2009, the authors performed 87 permanent tracheostomies. For the purpose of prevention of tracheostomal stenosis, we had applied new technique from October 2005.
The incidence of the tracheostomal stenosis was retrospectively reviewed. Until September 2005, conventional permanent tracheostomy was applied for 33 cases and tracheostomal stenosis developed in 6 cases (18.2%). On the other hand, stenosis did not develop in any of the 54 cases in which the new technique was used. The triangular method was significantly superior to the conventional method in preventing stenosis. Stomal recurrence did not develop in either technique.
The key point of the new technique is as follows: at the upper end of trachea, the posterior part of tracheal cartilage is preserved and the anterior edge of the tracheostoma is made much lower. The shape of the tracheostoma approximates a triangle, and the area is greater than with other methods. From our experience, this technique is safe and effective for the prevention of tracheostomal stenosis.
全喉切除术后永久性气管造口狭窄会降低术后生活质量（QOL），预防该狭窄在临床上具有重要意义。
2003年4月至2009年3月，作者实施了87例永久性气管造口术。为预防气管造口狭窄，自2005年10月起应用了新技术。
对气管造口狭窄的发生率进行了回顾性分析。截至2005年9月，33例采用传统永久性气管造口术，其中6例发生气管造口狭窄（18.2%）。另一方面，采用新技术的54例中无一例发生狭窄。在预防狭窄方面，三角形法明显优于传统方法。两种技术均未出现造口复发。
新技术的要点如下：在气管上端，保留气管软骨的后部，使气管造口的前缘更低。气管造口的形状近似三角形，面积比其他方法更大。根据我们的经验，该技术在预防气管造口狭窄方面安全有效。
