Ansari Ashfaque, Thomas Annju
E. N. T. Department, MGM Medical College and Hospital, Aurangabad, Maharashtra, India.
Case Rep Otolaryngol. 2018 Apr 1;2018:4583726. doi: 10.1155/2018/4583726. eCollection 2018.
Postintubation laryngotracheal stenosis requires a precise diagnosis and an experienced operator in both endoscopic and surgical treatment. This report presents surgically treated cases of laryngotracheal stenosis secondary to long-term intubation/tracheostomy with review of the literature.
In this retrospective study, we present 5 cases (a 23-year-old male, 13-year-old male, 22-year-old male, 19-year-old male, and 33-year-old female) of postintubation/tracheostomy laryngotracheal (glottic/subglottic) stenosis in the years 2016 and 2017. Each patient was managed differently. Intubation characteristics, localization of stenosis, surgical technique and material, postoperative complications, and survival of patients were recorded.
The site of stenosis was in the subglottis in 4 patients and glottis in 1 patient. The mean length of the stenosis was greater in the postintubation group. Postintubation stenosis had a mean duration of intubation of 6.8 days, compared to 206.25 days of cannulation following tracheostomies. Each patient underwent an average of 2 procedures during their treatment course. One patient underwent open surgical anastomosis because of recurrent subglottic stenosis after multiple treatments. Phonation improved immediately in almost all except in the patient who underwent only endoscopic dilatation.
The reasons for laryngeal stenosis and its delayed diagnosis have been reviewed from the literature. Suture tension should be appropriate, and placement of the suture knot outside the trachea minimizes formation of granulation tissue. The published reports suggest that resection by endoscopy with laser and open technique resection and primary anastomosis are the best treatment modality so far as the long-term results are concerned.
Resection of stenotic segment by open surgical anastomosis and laser-assisted resection is a safe option for the treatment of subglottic stenosis following intubation without the need for repeated dilation. Endoscopic dilation can be reserved for unfit patients.
插管后喉气管狭窄在内镜和手术治疗中都需要精确的诊断和经验丰富的操作者。本报告介绍了长期插管/气管切开后继发喉气管狭窄的手术治疗病例，并对相关文献进行了综述。
在这项回顾性研究中，我们呈现了2016年和2017年5例插管/气管切开后喉气管（声门/声门下）狭窄的病例（1例23岁男性、1例13岁男性、1例22岁男性、1例19岁男性和1例33岁女性）。每位患者的治疗方式不同。记录了插管特征、狭窄部位、手术技术和材料、术后并发症以及患者的生存情况。
4例患者的狭窄部位在声门下，1例在声门。插管后狭窄组的狭窄平均长度更长。插管后狭窄的平均插管时间为6.8天，而气管切开后的插管时间为206.25天。每位患者在治疗过程中平均接受了2次手术。1例患者因多次治疗后声门下狭窄复发而接受了开放性手术吻合术。除仅接受内镜扩张的患者外，几乎所有患者的发声立即得到改善。
从文献中回顾了喉狭窄的原因及其延迟诊断的情况。缝线张力应适当，将缝线结置于气管外可最大限度减少肉芽组织的形成。已发表的报告表明，就长期结果而言，内镜激光切除术和开放性技术切除及一期吻合术是最佳治疗方式。
开放性手术吻合和激光辅助切除狭窄段是治疗插管后声门下狭窄的安全选择，无需反复扩张。内镜扩张可用于不适合手术的患者。
