Burstein F D, Canalis R, Ward P H
Laryngoscope. 1986 May;96(5):516-20. doi: 10.1288/00005537-198605000-00009.
The surgical correction of severe laryngotracheal stenosis remains a challenging problem. We report on a series of 20 patients treated with the composite hyoid-sternohyoid interposition graft (HSIG). They range in age from 1 to 66 years and all had severe subglottic stenosis refractory to dilatation and stenting procedures. The major cause of stenosis was prolonged endotracheal intubation (16/20); the majority of patients (13/20) had severe medical illness complicating their airway management. Postoperative results were judged on the basis of decannulation, voice strength, and quality as well as activity tolerance. Follow-up periods were over 24 months in all cases. Twelve patients were decannulated and three keep their tracheotomy tubes permanently plugged. All have socially acceptable voices and good activity tolerance. Seven patients who were aphonic had voice improvement. There were three complete failures; one secondary to infection, one due to severe scleroderma, and one because of graft displacement. Each patient underwent an average of four postoperative endoscopies for airway evaluation and removal of granulation tissue. CAT scanning was useful in diagnosing postoperative problems, especially graft displacement, which was impossible to diagnose by endoscopic examination. We conclude that the composite hyoid-sternohyoid interposition graft is a useful and reliable tool in the treatment of subglottic stenosis.
严重喉气管狭窄的外科矫治仍然是一个具有挑战性的问题。我们报告了一组20例接受舌骨-胸骨舌骨肌复合植入物（HSIG）治疗的患者。他们的年龄从1岁到66岁不等，均患有严重的声门下狭窄，对扩张和支架置入术无效。狭窄的主要原因是长期气管插管（16/20）；大多数患者（13/20）患有严重的内科疾病，使气道管理复杂化。术后结果根据拔管情况、声音强度和质量以及活动耐量来判断。所有病例的随访期均超过24个月。12例患者拔管，3例患者永久性封堵气管切开管。所有患者的声音在社交上均可接受，活动耐量良好。7例失声患者声音有所改善。有3例完全失败；1例继发于感染，1例由于严重硬皮病，1例由于植入物移位。每位患者平均接受4次术后内镜检查以评估气道并清除肉芽组织。计算机断层扫描（CAT）有助于诊断术后问题，尤其是植入物移位，这是内镜检查无法诊断的。我们得出结论，舌骨-胸骨舌骨肌复合植入物是治疗声门下狭窄的一种有用且可靠的工具。
