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气管狭窄及其处理——单机构10年经验

Tracheal Stenosis and its Management - A Single Institution 10 Years Experience.

作者信息

Bansal Aman, Sharma Aditi, Jaiswal Ashwin Ashok, Umredkar Girish, Garg Amrish Kumar, Banerjee Praveer Kumar, Sharma Neeta, Mene Prachi, Dwivedi Vineeta, Anand Tanuja, Agrawal Amit

机构信息

Department of ENT & Head Neck Surgery, J.L.N.Hospital & Research Centre, Bhilai, (C.G) India.

Department of Anaesthesia, J.L.N.Hospital & Research Centre, Bhilai, (C.G) India.

出版信息

Indian J Otolaryngol Head Neck Surg. 2025 Jul;77(7):2575-2584. doi: 10.1007/s12070-025-05576-4. Epub 2025 May 22.

Abstract

To analyze patient characteristics, diagnostic methods, management strategies and outcomes in tracheal stenosis following intubation or tracheostomy over a 10-year period at a tertiary care center. Retrospective observational study. Tertiary care hospital. Eighteen patients diagnosed with tracheal stenosis from 2015 to 2024 following extubation or decannulation. Data collection included patient demographics, stenosis characteristics (type and site), diagnostic approaches, treatment modalities and outcomes. Patients were evaluated through history, physical examination, and endoscopic/imaging assessments. Management included endoscopic and open surgical interventions. Treatment success was defined as decannulation with satisfactory voice quality. Among 18 patients, middle-aged males were the predominant demographic and typically presented within 20 days post-extubation or decannulation. Of the 9 post intubation tracheal stenosis cases, 6 had web-like stenosis at the cuff site and 3 developed granulation tissue. The remaining 9 cases were post tracheostomy-related, with 4 showing granulation at the stoma, 3 involving cartilage fractures and 2 developing web-like stenosis. Endoscopic management (44.4%) involved bronchoscopic or bougie dilatation with mitomycin C application. Surgical interventions (55.5%) used composite hyoid-sternohyoid grafts (50%), costal cartilage (30%), and tracheoplasty with T-tube placement (20%). Decannulation was successful in 71.4% of endoscopic and 66.6% of surgical cases. Comprehensive evaluation and individualized management based on stenosis characteristics are essential for optimal outcomes in tracheal stenosis.

摘要

分析一家三级医疗中心10年间插管或气管切开术后气管狭窄患者的特征、诊断方法、管理策略及预后。回顾性观察研究。三级医疗医院。18例2015年至2024年拔管或拔管后诊断为气管狭窄的患者。数据收集包括患者人口统计学信息、狭窄特征(类型和部位)、诊断方法、治疗方式及预后。通过病史、体格检查以及内镜/影像学评估对患者进行评估。管理措施包括内镜及开放手术干预。治疗成功定义为拔管且嗓音质量满意。18例患者中,中年男性占主要人群,通常在拔管或拔管后20天内出现症状。9例插管后气管狭窄病例中,6例在套管部位有蹼状狭窄,3例出现肉芽组织。其余9例与气管切开术相关,4例在造口处出现肉芽,3例涉及软骨骨折,2例出现蹼状狭窄。内镜治疗(44.4%)包括支气管镜或探条扩张并应用丝裂霉素C。手术干预(55.5%)采用复合舌骨-胸骨舌骨移植(50%)、肋软骨(30%)以及带T形管置入的气管成形术(20%)。内镜治疗病例中71.4%拔管成功,手术病例中66.6%拔管成功。基于狭窄特征进行综合评估和个体化管理对于气管狭窄的最佳预后至关重要。

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