Huang Gui, He Jie, Li Shanna
Department of Pulmonary and Critical Care Medicine, Clinical Medical College & Affiliated Hospital of Chengdu University, Chengdu, China.
Department of Pulmonary and Critical Care Medicine, Clinical Medical College and The First Affiliated Hospital of Chengdu Medical College, Chengdu, China. Email:
Ann Palliat Med. 2021 Jan;10(1):194-201. doi: 10.21037/apm-20-2475.
The incidence of subglottic stenosis is rising year by year. For this difficult clinical problem, the efficacies of surgical and bronchoscopic intervention treatments vary. A simple and effective method to affix silicone stents is needed for the treatment of subglottic stenosis.
Eight patients suffering from subglottic stenosis underwent straight silicone stent placement with external fixation in the First Affiliated Hospital of Chengdu Medical College between January 2015 and August 2019. All patients received regular postoperative bronchoscopy. A retrospective analysis was conducted to analyze the efficacy and complications of the operation.
Straight silicone stent placement was successful in seven patients and the external fixation of stents was completed. Symptoms of dyspnea were resolved in seven cases (87.5%), and the mean diameter of the upper trachea was significantly increased from 3.54±0.59 to 12.71±2.42 mm after the operation (t=15.78, P=0.002). The modified Medical Research Council dyspnea scale score significantly decreased from 3.4 (2.7, 3.8) to 0.8 (0.4, 1.4) after the operation (Z=-6.63, P=0.001). Postoperative complications were observed, including one case of mediastinal emphysema and pneumothorax, two cases of granulation tissue hyperplasia, four cases of intractable cough, six cases of postoperative infection at the external fixation site, one case of postoperative bleeding, and one case of sputum retention. All were promptly treated and quickly controlled. No stent displacement was observed during follow-up.
External fixation of straight silicon stents for the treatment of subglottic stenosis had good short-term outcomes and stable stent fixation. The proportion of postoperative infections was high. Therefore, the advantages and disadvantages of this operation need to be considered.
声门下狭窄的发病率逐年上升。针对这一临床难题，手术和支气管镜介入治疗的疗效各异。治疗声门下狭窄需要一种简单有效的硅酮支架固定方法。
2015年1月至2019年8月期间，8例声门下狭窄患者在成都医学院第一附属医院接受了直形硅酮支架外置固定置入术。所有患者术后均接受定期支气管镜检查。进行回顾性分析以分析手术的疗效和并发症。
7例患者直形硅酮支架置入成功并完成支架外置固定。7例（87.5%）患者呼吸困难症状得到缓解，术后气管上段平均直径从3.54±0.59显著增加至12.71±2.42mm（t=15.78，P=0.002）。改良医学研究委员会呼吸困难量表评分术后从3.4（2.7，3.8）显著降至0.8（0.4，1.4）（Z=-6.63，P=0.001）。观察到术后并发症，包括1例纵隔气肿和气胸、2例肉芽组织增生、4例顽固性咳嗽、6例外置固定部位术后感染、1例术后出血和1例痰液潴留。所有并发症均得到及时治疗并迅速得到控制。随访期间未观察到支架移位。
直形硅酮支架外置固定治疗声门下狭窄近期疗效良好，支架固定稳定。术后感染比例较高。因此，需要综合考虑该手术的利弊。
