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[气管切除治疗肉芽肿性多血管炎(韦格纳氏病)患者插管后声门下狭窄]

[Tracheal resection for post-intubation subglottic stenosis in a patient with granulomatosis with polyangiitis (Wegener)].

作者信息

Stoica Radu, Negru Irina, Matache Radu

出版信息

Pneumologia. 2014 Jul-Sep;63(3):174-7.

Abstract

Granulomatosis with polyangiitis (GPA or Wegener) is a systemic autoimmune disease with inflammation of small- and medium-size vessels. It can affect practically any organ or system, but renal, respiratory andjoint systems are most frequently damaged. Positive pANCA antibodies can raise the suspicion of diagnosis. Subglottic stenosis is relatively frequent, in a quarter of patients, especially in the third decade women. The case presented is of an 80-year-old woman, recently diagnosed with pulmonary, renal and systemic manifestations of GPA and with a subglottic stenosis rapidly evolving towards endotracheal intubation, tracheostomy with mechanical ventilation and renal failure. Further evolution has been favorable under corticoid therapy. After weaning from the mechanical ventilation and30 days after the suppression of the tracheostomy, the patient developed a tracheal stenosis with mixed etiology, secondary to vasculitis and prolonged intubation with tracheostomy. Tracheal resection with termino-terminal anastomosis was performed in emergency with simple post-operative evolution and without late complications.

摘要

肉芽肿性多血管炎(GPA 或韦格纳氏病)是一种累及中小血管的系统性自身免疫性疾病。它几乎可影响任何器官或系统,但肾脏、呼吸系统和关节系统最常受损。抗中性粒细胞胞浆抗体(pANCA)阳性可增加诊断怀疑。声门下狭窄相对常见,在四分之一的患者中出现,尤其是在 30 岁左右的女性中。本文报道的病例是一位 80 岁女性,近期诊断为 GPA 的肺部、肾脏及全身表现,伴有声门下狭窄且迅速发展至需要气管插管、气管切开并机械通气以及肾衰竭。在皮质类固醇治疗下病情进一步好转。在机械通气撤机及气管切开拔除 30 天后,患者出现了混合病因的气管狭窄,继发于血管炎及长期气管插管和气管切开。急诊行气管切除端端吻合术,术后恢复顺利,无晚期并发症。

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