Stern Y, Willging J P, Cotton R T
Department of Pediatric Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center and University of Cincinnati College of Medicine, Ohio, USA.
Ann Otol Rhinol Laryngol. 1998 Dec;107(12):1006-9. doi: 10.1177/000348949810701202.
Montgomery T-tubes are often used in adult patients; however, they are less commonly used in the pediatric age group. The purpose of this report is to describe our experience with this stent in pediatric laryngotracheal reconstruction. A retrospective chart review was performed to identify early and late complications. Nutritional assessments were made on the basis of weight percentile comparisons at the time of surgery and at the end of the stenting period. From 1990 to 1997, the Montgomery T-tube was utilized in 26 children undergoing 36 airway reconstruction procedures (21 laryngotracheoplasties and 15 cricotracheal resections). The upper limb of the tube extended above the level of the glottis in all patients. The patients ranged in age from 2.4 to 17.9 years. The duration of stenting ranged from 2 weeks to 23 months. Three patients (11.5%) had significant aspiration and did not improve following diet modifications and swallowing therapy, requiring tube feedings. One patient had postoperative subcutaneous emphysema that resolved spontaneously. Three patients required early removal of the stent due to an inability to tolerate plugging. Granulation tissue above the upper limb of the stent during the stenting period was noted after 6 laryngotracheal reconstruction procedures (16%). Only 1 patient fell off his growth curves during the period of stenting. There were no deaths in this series, and no emergent procedures were required. Postoperative and home care and management of complications are discussed. Our experience indicates that Montgomery T-tubes can be utilized relatively safely in children, providing that postoperative and home care are meticulous.
蒙哥马利T形管常用于成年患者；然而，它们在儿科年龄组中使用较少。本报告的目的是描述我们在儿科喉气管重建中使用这种支架的经验。进行了回顾性病历审查以确定早期和晚期并发症。根据手术时和支架置入期结束时的体重百分位数比较进行营养评估。1990年至1997年，26名儿童接受了36次气道重建手术（21次喉气管成形术和15次环状气管切除术），使用了蒙哥马利T形管。所有患者的T形管上肢均延伸至声门水平以上。患者年龄在2.4岁至17.9岁之间。支架置入时间为2周至23个月。3名患者（11.5%）有明显误吸，在调整饮食和吞咽治疗后无改善，需要管饲。1名患者术后出现皮下气肿，自行消退。3名患者因无法耐受堵塞而需要早期取出支架。在6次喉气管重建手术后（16%），在支架置入期发现支架上肢上方有肉芽组织。在支架置入期间，只有1名患者生长曲线下降。本系列无死亡病例，也无需急诊手术。讨论了术后及家庭护理和并发症的处理。我们的经验表明，只要术后和家庭护理细致，蒙哥马利T形管在儿童中可以相对安全地使用。
