Surgical management of laryngotracheal stenosis:a retrospective study of 53 cases
10.3321/j.issn:1673-0860.2008.12.011
- VernacularTitle:喉气管狭窄外科治疗效果的分析
- Author:
Chun-Yan WANG
1
;
Yong QIN
Author Information
1. 北京大学首钢医院
- Keywords:
laryngostenosis;
Tracheal stenosis;
Otorhinolaryngologie surgical procedures;
Dilatation;
Stents
- From:
Chinese Journal of Otorhinolaryngology Head and Neck Surgery
2008;43(12):919-923
- CountryChina
- Language:Chinese
-
Abstract:
Objective To analyze the etiology,means of diagnosis and surgical approaches fur the treatment of laryngotracheal stenosis(LTS),and to evaluate their effects on the outcome of surgical management of LTS.Methods Fifty-three patients with benign LTS were retrospectively studied fur the clinical trial in Peking University.First Hospital,ENT Head & Neck Department between April 1989 and April 2005.The fullow-up ranged from 1 to 16 years.The surgical approaches included endoscopic removal of the obstruction with or without CO2 Laser and open surgical techniques.Open surgical techniques included scar resection,arytenoidectomy,laryngoplasty with hyoid bone and end-to-end anastomosis.A number of grafts(cartilage,hyoid bone)and intraluminal stents were used.Statistical analysis was performed by the X2 tesL Results The overall success was achieved in 38 of 53 patients(71.7%).Three cases were lost of follow-up and 12 cases were lived with endotrachcal tube in place.As for the surgicol approach,19 cases (35.8%)were done by open surgical technique and 34 Cases(64.2%)by endoscopic approach.The successful rates were 73.7%(14/19)and 70.6%(24/34)respectively.There were 31 cases of isolated stenosis with a successful rate of 87.1%(27/31)and 22 cases of multiple sites with a Successful rate of 50.0%(1 1/22).Isolated stenosis had a statistically better result than multiple stenosis through the X2 test (X2=8.727,P=0.003).As for the length of stenosis,47 eases were less than 3 cm with a successful rate of 80.8%(38/47),6 cases were longer than 3 cm with no success.The stenosis of less than 3 cm had a statistically better result than longer stenosis through the X2test(X2=17.140,P=0.000).According to the Cotton grading system of LTS,there were 28 cases of Grade 1 with a suceessful rate of 96.4%(27/28)and 25 cases of Grade Ⅱ-Ⅳ with a Successful rate of 44.0%(11/25).Grade I stenosis according to Cotton grading system of LTS had better prognosis than GradeⅡ-Ⅳ(X2=17.891,P=0.000).As fur the stents,finger cot usage of one case was successful,while laryngeal stents had a successful rate of 72.2%(13/18)and T tube of 25.0%(1/4).Six eases of hyoid graft with stornohyoid muscle flap were suuess.Conclusions Surgical approaches of LTS should be chosen according to the site,length and diameter of stenosis.The operative efficacy ranged from case to case,while shorter stenosis and isolated stenosis might be easier to handle than multiple stenosis.The use of stents and interposition grafts were also helpful in some cases.
