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[气管切开术后喉完全瘢痕性闭锁及气管狭窄合并环状软骨骨折患者的喉气管切除及气管食管瘘闭合术]

[Laryngotracheal resection with tracheoesophageal fistula closure in a patient with post-tracheostomy total cicatricial atresia of the larynx and tracheal stenosis combined with cricoid cartilage fracture].

作者信息

Pechetov A A, Vishnevskaya G A

机构信息

Vishnevsky National Medical Research Center of Surgery, Moscow, Russia.

出版信息

Khirurgiia (Mosk). 2024(10):109-114. doi: 10.17116/hirurgia2024101109.

Abstract

Treatment of patients with post-intubation (post-tracheostomy) stenotic laryngotracheal lesions combined with tracheoesophageal fistula is the most difficult problem for various specialists. A 20-year-old patient received a severe concomitant injury with necessary prolonged mechanical ventilation and tracheostomy. Decannulation was followed by shortness of breath and cough with discharge of sputum mixed with liquid and food. Post-tracheostomy total cicatricial atresia of the larynx and cervical trachea combined with cricoid cartilage fracture, as well as tracheoesophageal fistula of cervical trachea was diagnosed. Tracheostomy and gastrostomy were performed. After 3-month rehabilitation, the patient admitted to the Vishnevsky National Medical Research Center of Surgery. After additional examination, the patient underwent circular laryngotracheal resection, closure of tracheoesophageal fistula, laryngotracheal reconstruction (laryngotracheal anastomosis by Grillo with thyroid cartilage repair), re-tracheostomy. A favorable outcome was obtained. In such patients, treatment strategy cannot be standardized and require a personalized approach.

摘要

对于各类专科医生而言,治疗气管插管(气管切开术后)狭窄性喉气管病变合并气管食管瘘的患者是最为棘手的问题。一名20岁患者遭受了严重的合并伤,需要长时间机械通气和气管切开术。拔管后出现呼吸急促和咳嗽,咳出的痰液中混有液体和食物。诊断为气管切开术后喉和颈段气管完全瘢痕性闭锁合并环状软骨骨折,以及颈段气管食管瘘。进行了气管切开术和胃造瘘术。经过3个月的康复治疗后,该患者入住维什涅夫斯基国家医学研究外科中心。经过进一步检查,患者接受了环状喉气管切除术、气管食管瘘闭合术、喉气管重建术(Grillo法喉气管吻合术并修复甲状软骨)、再次气管切开术。获得了良好的治疗效果。对于此类患者,治疗策略无法标准化,需要个性化的治疗方法。

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