Coordes Annekatrin, Todt Ingo, Ernst Arne, Seidl Rainer O
Unfallkrankenhaus Berlin, Department of Otolaryngology at UKB, Charité Medical School, Berlin, Germany.
Int J Pediatr Otorhinolaryngol. 2013 May;77(5):857-62. doi: 10.1016/j.ijporl.2013.02.012. Epub 2013 Mar 13.
Laryngotracheal stents may damage the highly complex laryngeal structures, impair voice and swallowing functions and cause tissue ingrowths, thereby necessitating airway patency interventions. In benign airway disease, the number of adolescents with laryngotracheal stents is therefore limited. We present two cases of laryngeal metallic stent placement following benign airway disease. Two adolescents presented with severe dyspnea and self-expandable metallic stent placement after benign laryngotracheal stenoses. Granulation tissue ingrowths required additional surgical interventions every 6-8 weeks to recanalize the stent lumen. We performed multi-stage surgery including removal of the embedded stent, segmental resection of the stenotic area, end-to-end-anastomosis and laryngotracheal reconstruction respectively, to achieve patent airway without tracheal cannulation. Montgomery T-tubes were temporarily inserted to bridge the complex reconstructions. In both adolescents, we achieved successful removal of the embedded stent and patent airway. Bilateral vocal fold paralysis required additional surgery to improve the final airway patency and vocal rehabilitation. Stent removal, segmental resection and laryngotracheal reconstruction provide the achievement of patent airway and allow decannulation. Temporary Montgomery T-tubes bridge complex laryngotracheal reconstructions. In benign laryngeal airway disease, stent placement should be avoided, especially in adolescents. Transfer to a specialist center should be considered prior to metallic stent implantation. In general, self-expanding tracheobronchial stents can be placed in selected patients where surgical interventions are limited.
喉气管支架可能会损伤高度复杂的喉部结构，损害发声和吞咽功能，并导致组织向内生长，从而需要进行气道通畅干预。因此，在良性气道疾病中，植入喉气管支架的青少年数量有限。我们报告两例良性气道疾病后喉金属支架置入的病例。两名青少年因良性喉气管狭窄出现严重呼吸困难并接受了自膨式金属支架置入。肉芽组织向内生长需要每6 - 8周进行额外的手术干预以重新打通支架管腔。我们分别进行了多阶段手术，包括取出嵌入的支架、狭窄区域的节段性切除、端端吻合和喉气管重建，以实现气道通畅且无需气管插管。暂时插入蒙哥马利T形管以衔接复杂的重建手术。在这两名青少年中，我们成功取出了嵌入的支架并实现了气道通畅。双侧声带麻痹需要额外的手术来改善最终的气道通畅情况和声带康复。取出支架、节段性切除和喉气管重建可实现气道通畅并允许拔管。临时的蒙哥马利T形管可衔接复杂的喉气管重建手术。在良性喉气道疾病中，应避免放置支架，尤其是在青少年中。在植入金属支架之前应考虑转至专科中心。一般来说，自膨式气管支气管支架可放置于手术干预受限的特定患者中。
