Objective To discuss the cause and treatment strategy for open laryngotracheal trauma.Methods The clinical data of 38 cases with open laryngotracheal trauma admitted from 1998 to 2012 were collected and analyzed.Of them,one patient died in emergency department despite energetic resuscitation,37 were hospitalized and given advanced treatment after life support measures in emergency department.They were treated with tracheotomy before or during operation.Of them,32 patients were regularly followed up for imaging studies.Result Except 1 patient died of exsanguination from carotid artery rupture,the other 37 survived after successful treatment.Twenty patients were treated with debridement and suture of the wounds and laryngoplasty (20/37,54.1％),8 patients were operated with laryngoplasty plus intraluminal stents implanted (8/37,21.6％) ; the rest 9 patients (9/37,24.3％) were separately given placement of nickel-titanium shape memory alloy stent (n =2),laryngofissure with rubber gloves throat models implanted and laryngoplasty (n =3),linear silicone tube implanted and laryngoplasty with trans-cervical approach (n =1) and tracheoesophageal fistula neoplasty with laryngoplasty and laryngofissure (n =3).The operated patients were followed-up for 0.5 to 3 years after discharge.Of them,35 patients (35/37,94.6％) had successful decannulation,breathing smoothly and swallowing normally,23 patients (23/37,62.2％) had almost normal pronunciation,12 patients (12/37,32.4％) had different degrees in hoarseness of voice,and 2 patients (2/37,5.4％) were referred to other hospital because of failure in extubation with severe stenosis of laryngotrachea.Conclusions When the patients with open laryngotracheal trauma were treated,the essential strategy was to prevent shock,hemorrhage,and asphyxia.In the case of patent respiratory tract and stable vital signs,laryngotracheal reconstruction should be carried out as soon as possible to prevent complications,thereby obtaining good therapeutic effect.

Objective : To investigate the predictive value of platelet volume distribution width ( PDW) , mean platelet volume (MPV) , and D ⁃dimer (D⁃D) on early shunt dysfunction in patients with decompensated cirrhosis treated with transjugular intrahepatic portosystemic shunt(TIPS) . Methods : A total of 28 patients with decompensated cirrhosis who developed shunt dysfunction within 6 months after TIPS were selected as the case group , and a 1 ∶ 2 matched control study was conducted. 56 patients matched by age ( ± 2) and gender who did not develop shunt dysfunction within 6 months after TIPS were selected as the control group. Spss23. 00 software was used to conduct univariate analysis to obtain statistically significant variables , and then conditional Logistic regression analysis was conducted with paired design , with P < 0. 05 being statistically significant. Results : Patients with a history of splenectomy , portal vein thrombosis , and those with poor liver function grade were more likely to have functional dysfunction after TIPS. Platelet count (PLT) , platelet volume distribution width (PDW) , mean platelet volume (MPV) , D ⁃dimer ( D⁃D) and Fibrinogen monomer ( FDPI) had statistically significant differences between the case group and the control group. The values of D ⁃D、PDW、MPV and FDPI in the case group were higher than those in the control group , while the value of PLT in the case group was lower than that in the control group. The OR values of PDW , MPV and D ⁃D were 2. 164 , 3. 826 and 1. 382 , respectively. ROC analysis results showed that the areas under PDW , MPV and D ⁃D curves were 0. 746 , 0. 773 and 0. 690 , respectively. Conclusion Compared with ultrasound , D ⁃D , PLT and PDW could predict shunt dysfunction earlier after TIPS. Patients with normal shunt function indicated by color Doppler ultrasonography in postoperative follow⁃up of TIPS should be closely observed for indicators such as D ⁃D , PLT and PDW , which is of important significance for clinical indication of shunt dysfunction in TIPS.