Maniglia A J
Otolaryngol Clin North Am. 1979 Nov;12(4):877-92.
Tracheal and laryngeal stenosis has become increasingly common following prolonged intubation or tracheostomy for mechanical ventilation and is directly related to trauma. Tracheal resection up to 4 to 5 cm. with an end to end anastomosis is the generally accepted treatment. However, tracheal resection carries the danger of mortality and considerable morbidity. From 1974 to 1979 all patients in our series with tracheal stenosis, even with laryngeal involvement, regardless of etiology and age were intiially treated by conservative surgical management consisting of dilation, severance of the stenotic ring, intralesional injection of triamcinolone acetonide, and stenting with a silicone T tube for 90 days. Sixteen of 19 patients obtained good results and enjoy an adequate airway without a tracheostomy tube. The longest follow-up period was five years and the shortest, six months. Intralesional injection of triamcinolone acetonide is essential for successful treatment. No mortality or serious complications resulted from this treatment. Our experience indicates that patients with tracheal and laryngeal stenosis should undergo a primarily conservative surgical management. This technique appears worthy of trial prior to contemplating a more extensive procedure.
气管和喉狭窄在因机械通气而长期插管或气管切开术后变得越来越常见，并且与创伤直接相关。切除长达4至5厘米的气管并进行端端吻合术是普遍接受的治疗方法。然而，气管切除术存在死亡风险和相当高的发病率。从1974年到1979年，我们系列中的所有气管狭窄患者，即使伴有喉部受累，无论病因和年龄如何，最初均采用保守手术治疗，包括扩张、切断狭窄环、病灶内注射曲安奈德以及用硅胶T管支架置入90天。19例患者中有16例取得了良好效果，无需气管造口管即可保持气道通畅。最长随访期为五年，最短为六个月。病灶内注射曲安奈德是成功治疗的关键。该治疗未导致死亡或严重并发症。我们的经验表明，气管和喉狭窄患者应首先接受保守手术治疗。在考虑更广泛的手术之前，这种技术似乎值得一试。
