Couraud L, Jougon J B, Velly J F
Thoracic Surgery Unit, Xavier Arnozan Hospital, Pessac (Bordeaux), France.
Ann Thorac Surg. 1995 Aug;60(2):250-9; discussion 259-60. doi: 10.1016/0003-4975(95)00464-v.
After 1970, the widespread use of nasotracheal intubation, avoiding tracheostomy and its pitfalls, resulted in more frequent laryngeal or laryngotracheal stenoses, which required more complex and sometimes multistaged procedures.
A series of 217 nontumoral stenoses of the upper airway were treated following the same therapeutic principles in the period 1978 to 1992. Two hundred one of them were iatrogenic postintubation strictures (92%); the others were posttraumatic (7), idiopathic (5), and various (4).
One hundred twenty (55%) were tracheal stenoses and treated by resection and primary end-to-end anastomosis with 117 excellent or good results and three deaths. Length of the stenosis, old age, neuropsychological sequelae, and overall poor respiratory status of the patients made up the remaining difficulties in the treatment. Ninety-seven (45%) were laryngotracheal stenoses with much more complex surgical indications: 57 patients underwent tracheal and subglottic resection and anastomosis with 56 successes and one death, 7 had laryngotracheal resection and anastomosis with total cricoidectomy and consequently laryngeal stenting for 3 to 6 months (six successes, one death), 3 had supraglottic resection and anastomosis (three successes), 12 patients with glottic opening difficulties and short laryngeal stenosis underwent a laryngeal enlargement over a T tube without resection (11 successes, one death), and 18 were subjected to a complex combination of resection and modeling with 16 successes, 2 failures, and 1 death. Final results were successful in 208 cases (96%) with seven deaths and two failures. Mild phonetic sequelae were observed after laryngeal modeling. A minimal follow-up of 1 year has shown long-term stability of most repairs.
Despite acceptable results, the therapeutic approach remains difficult for laryngotracheal stenoses involving the glottic and the supraglottic level as well as for those that have not responded to previous attempts at repair. In a few cases, despite a meticulous preoperative assessment, the surgical strategy can only be adopted intraoperatively. The key to surgical success is undoubtedly a careful preoperative treatment of infection and inflammation as well as a meticulous muco-mucosal approximation of healthy margins at the anastomosis.
1970年后，鼻气管插管的广泛应用避免了气管切开及其相关问题，但导致喉或喉气管狭窄更为常见，这需要更复杂且有时需分阶段进行的手术。
1978年至1992年期间，按照相同的治疗原则对217例上气道非肿瘤性狭窄进行了治疗。其中201例为医源性插管后狭窄（92%）；其他为创伤后狭窄（7例）、特发性狭窄（5例）及其他类型（4例）。
120例（55%）为气管狭窄，采用切除并一期端端吻合术治疗，117例效果优良，3例死亡。狭窄长度、患者高龄、神经心理后遗症以及总体较差的呼吸状况构成了治疗中的其他困难。97例（45%）为喉气管狭窄，手术指征更为复杂：57例患者接受气管及声门下切除并吻合术，56例成功，1例死亡；7例接受喉气管切除并吻合术，同时行全环状软骨切除术，随后行喉支架置入3至6个月（6例成功，1例死亡）；3例接受声门上切除并吻合术（3例成功）；12例声门开放困难且喉狭窄较短的患者在未行切除的情况下通过T形管进行喉扩大术（11例成功，1例死亡）；18例接受了切除与塑形的复杂联合手术，16例成功，2例失败，1例死亡。最终结果208例成功（96%），7例死亡，2例失败。喉塑形术后观察到轻度语音后遗症。至少1年的随访显示大多数修复具有长期稳定性。
尽管结果尚可，但对于累及声门和声门上水平的喉气管狭窄以及对先前修复尝试无反应的狭窄，治疗方法仍然困难。在少数情况下，尽管进行了细致的术前评估，但手术策略只能在术中采用。手术成功的关键无疑是术前仔细治疗感染和炎症，以及在吻合处精心进行健康边缘的粘膜对粘膜贴合。
