Department of Otorhinolaryngology, Head and Neck Surgery, University Hospital CHUV, Lausanne, Switzerland.
Eur Arch Otorhinolaryngol. 2012 Dec;269(12):2531-8. doi: 10.1007/s00405-012-2080-x. Epub 2012 Jun 22.
The purpose of this study was to assess the safety and efficacy of stenting in upper airway reconstructions for benign laryngotracheal stenosis (LTS) with a newly designed prosthesis, the LT-Mold™. The LT-Mold and its proper use during open surgery and endoscopy are described, and the experience gathered from a prospectively collected database on 65 patients treated for complex LTS or severe aspiration is reported. This series is compared to the results of other stenting methods. All patients were available for evaluation. In all but one case, the prosthesis was removed at the end of the study. The new prosthesis did not induce any stent-related trauma to the supraglottis, glottis and subglottis. Before adding a distal round-shaped silicone cap to the LT-Mold, granulation tissue was usually seen at the stent-mucosal interface at the tracheostoma level. In 14 cases, there has been a spontaneous extrusion of the prosthesis through the mouth; this problem was solved by fixing the prosthesis through the reinforced portion of the prosthesis at the cap level and by adding one fixation stitch in the supraglottis. We have to document the loss of the silicone cap in three cases. This problem was resolved by designing a new prototype with an integrated cap, glued with a slow hardening silicone glue. Fifty-four (83 %) of 65 patients were decannulated after a mean duration of stenting of 3 months (range 1-12 months). The mean follow-up after decannulation was 23 months (range 1 month to 10 years). The experience gathered with the LT-Mold shows that long-term stenting for complex LTS is safely achieved when the prosthesis is used with its distal integrated silicone cap. The softness and smoothness of the prosthesis with a round-shaped configuration of both extremities help avoid ulceration and granulation tissue formation in the reconstructed airway. Adequate fixation is mandatory to avoid extrusion.
本研究旨在评估新型 LT-Mold™ 假体在上气道重建中治疗良性喉气管狭窄（LTS）的安全性和疗效。描述了 LT-Mold 及其在开放手术和内镜下的正确使用方法，并报告了在 65 例复杂 LTS 或严重吸入患者前瞻性数据库中收集的经验。本系列与其他支架方法的结果进行了比较。所有患者均可供评估。除 1 例外，所有患者在研究结束时均取出了假体。新型假体不会对上气道、声带和下气道造成任何与支架相关的创伤。在向 LT-Mold 添加远端圆形硅酮帽之前，通常会在气管造口水平的支架-黏膜界面看到肉芽组织。在 14 例中，假体已通过口腔自发挤出；通过在帽水平处通过假体的加强部分固定假体，并在声门上添加一个固定缝线解决了该问题。我们必须记录在 3 例中硅酮帽的丢失。通过设计具有集成帽的新型原型，并使用缓慢固化的硅酮胶进行胶合，解决了该问题。65 例患者中有 54 例（83%）在支架置入 3 个月（1-12 个月）后拔管。拔管后平均随访 23 个月（1 个月至 10 年）。使用带有远端集成硅酮帽的 LT-Mold 获得的经验表明，当使用这种假体时，可安全实现复杂 LTS 的长期支架置入。假体的柔软性和圆形两端的光滑度有助于避免再建气道中的溃疡和肉芽组织形成。必须进行充分固定以避免脱出。
