Kirasirova E A, Tyutina S I, Mironov A S, Borovkova N V, Lafutkina N V, Mamedov R F, Rezakov R A, Frolkina E A, Yumatova D A
Sverzhevsky Research Clinical Institute of Otorhinolaryngology, Moscow, Russia.
Pirogov Russian National Research Medical University, Moscow, Russia.
Vestn Otorinolaringol. 2024;89(3):11-17. doi: 10.17116/otorino20248903111.
The article presents an analysis of the plastic reconstructive surgery effectiveness for patients with an extended tracheal defect using an allograft based on the dura mater (DM) at the final stage of surgical treatment of laryngeal and tracheal cicatricial stenosis. The study included 20 patients with cicatricial stenosis of the larynx and trachea, who were previously performed plastic reconstructive treatment with scar tissue excision in the lumen of the respiratory tract and restoration of the supporting frame of the larynx and trachea using allografts based on costal allocartilage. The age of the patients ranged from 21 to 54 years, the duration of the disease was from 1 to 5 years. After a standard clinical and laboratory examination, with a mandatory video endoscopic examination of the larynx and trachea, multislice computed tomography of the larynx and trachea, patients underwent plastic closure of the tracheal defect using DM. Dynamic outpatient monitoring was carried out once a week for 1 month, once a month for 3 months, control examination was done 6 months after surgical treatment. The results of the study demonstrated a full-fledged social and labor rehabilitation of all 20 patients after the final stage of surgical treatment using DM, the absence of rejection reaction and migration of allo-implantation material, the preserved lumen of the larynx and trachea with a rigid supporting skeleton and the absence of anterior tracheal wall floatation. The use of DM as an additional strengthening of the anterior tracheal wall for patients with deficiency of muscular aponeurotic tissues and more than 2 cm size tracheal defect is highly effective at the final stage of surgical treatment for plastic closure of the tracheal defect.
本文介绍了在喉气管瘢痕性狭窄手术治疗的最后阶段，使用基于硬脑膜（DM）的同种异体移植物对气管大范围缺损患者进行整形修复手术的效果分析。该研究纳入了20例喉气管瘢痕性狭窄患者，这些患者此前已接受过呼吸道腔内瘢痕组织切除及使用肋软骨异体移植物修复喉气管支撑框架的整形修复治疗。患者年龄在21至54岁之间，病程为1至5年。在进行标准的临床和实验室检查，并对喉气管进行强制视频内镜检查以及喉气管多层计算机断层扫描后，患者使用DM进行气管缺损的整形闭合。术后1个月每周进行1次动态门诊监测，3个月内每月进行1次，手术治疗6个月后进行对照检查。研究结果表明，在使用DM进行手术治疗的最后阶段后，所有20例患者均实现了全面的社会和劳动康复，同种异体植入材料无排斥反应和移位，喉气管腔得以保留，具有坚固的支撑骨架，且气管前壁无漂浮现象。对于肌肉腱膜组织缺损且气管缺损大于2 cm的患者，在气管缺损整形闭合手术治疗的最后阶段，使用DM额外加固气管前壁非常有效。
