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舌骨-胸骨舌骨肌骨肌皮瓣联合异种脱细胞真皮基质治疗创伤性喉气管狭窄:病例报告及文献复习

Traumatic laryngotracheal stenosis treated by hyoid-sternohyoid osseomuscular flap combined with xenogenic acellular dermal matrix: A case report and literature review.

作者信息

Yang Hang, Chen Zhe, Zhou Shui-Hong, Wang Qin-Yin, Weng Li-Xia, Wang Fang, Wu Ting-Ting, Zhou Min-Li, Bao Yang-Yang

机构信息

1 Department of Otorhinolaryngology, First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou, Zhejiang, China.

2 Department of Otorhinolaryngology, People's Hospital of Jiangshan City, Zhejiang Province, China.

出版信息

J Int Med Res. 2017 Oct;45(5):1486-1494. doi: 10.1177/0300060517705985. Epub 2017 May 8.

Abstract

Objective The treatment of laryngotracheal stenosis is a major therapeutic challenge. Various treatments include observation, medical management, and surgical management. The most effective surgical management is resection and reconstruction. To the authors' knowledge, no reports have described the use of xenogenic acellular dermal matrix (ADM) for laryngotracheal stenosis. Methods A 27-year-old man presented with hemoptysis of the neck due to a traffic accident. Emergency orotracheal intubation was performed. Tracheostomy was then performed under local anesthesia. Computed tomography revealed fractures of the right thyroid cartilage and posterior arc of the cricoid cartilage and stenosis of the subglottis and first and second tracheal rings. We used a composite hyoid-sternohyoid osseomuscular flap with xenogenic ADM and a straight silicone tube as a lumen stent to reconstruct the laryngotracheal stenosis. Results Surgical recovery was uneventful. The tracheotomy opening was changed to a metal tube 5 days postoperatively. Four months postoperatively, the silicone tube was endoscopically removed under local anesthesia. The patient was decannulated 20 days later. The patient satisfied with his voice, respiration, and deglutition at the 16-month postoperative follow-up. Conclusion The use of ADM for laryngotracheal stenosis may reduce the growth of granulation tissues and promote the repair process.

摘要

目的 喉气管狭窄的治疗是一项重大的治疗挑战。各种治疗方法包括观察、药物治疗和手术治疗。最有效的手术治疗是切除和重建。据作者所知,尚无关于使用异种脱细胞真皮基质(ADM)治疗喉气管狭窄的报道。方法 一名27岁男性因交通事故出现颈部咯血。进行了紧急经口气管插管。随后在局部麻醉下进行了气管切开术。计算机断层扫描显示右侧甲状软骨和环状软骨后弓骨折,声门下及第一、二气管环狭窄。我们使用带异种ADM的复合舌骨-胸骨舌骨肌骨瓣和一根直硅胶管作为管腔支架来重建喉气管狭窄。结果 手术恢复顺利。术后5天气管切开开口更换为金属管。术后4个月,在局部麻醉下通过内镜取出硅胶管。20天后患者拔管。术后16个月随访时,患者对其声音、呼吸和吞咽情况满意。结论 使用ADM治疗喉气管狭窄可能减少肉芽组织生长并促进修复过程。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/aeef/5718716/b5d908a97e01/10.1177_0300060517705985-fig1.jpg

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