本文選題：喉氣管狹窄　切入點(diǎn)：瘢痕　出處：《重慶醫(yī)科大學(xué)》2017年碩士論文

【摘要】：目的探討喉氣管狹窄的手術(shù)治療方式和療效。方法回顧性分析2011年~2015年我科收治的48例喉氣管狹窄患者的臨床資料,其中6例拒絕手術(shù),42例納入隨訪分析。23例給予支撐喉鏡下CO2激光瘢痕切除術(shù)(其中2例術(shù)中給予平陽霉素注射),10例給予喉氣管成形+T管植入術(shù),2例給予胸鎖乳突肌鎖骨骨膜瓣喉氣管腔重建+T管植入術(shù),7例給予氣管袖狀切除+端端吻合+T管植入術(shù)。觀察患者的手術(shù)次數(shù)、拔管時間、術(shù)后吞咽進(jìn)食、活動耐量情況,評估手術(shù)療效。結(jié)果42例病人共67次手術(shù),激光手術(shù)35次,喉氣管成形+T管植入術(shù)18次,胸鎖乳突肌鎖骨骨膜瓣喉氣管腔重建+T管植入術(shù)7次,氣管袖狀切除+端端吻合+T管植入術(shù)7次。1次性手術(shù)治愈的有24例,2次手術(shù)3例,3次手術(shù)5例,4次手術(shù)1例,5次手術(shù)1例,6例長期帶管,2例死亡。手術(shù)效果理想有24例,基本理想有10例,無效8例,手術(shù)成功率為80.95%。24例術(shù)中置管,18例最終拔管,拔管率為75%。術(shù)后38例患者有不同程度的聲嘶,所有患者無吞咽困難、飲水嗆咳,3例患者出現(xiàn)活動耐量下降。結(jié)論術(shù)前要對患者病情充分評估,根據(jù)狹窄程度、部位、長度,狹窄平面多少,患者身體狀況以及是否為瘢痕體質(zhì)等選擇最佳的手術(shù)方式,減少手術(shù)次數(shù),同時,術(shù)后還可以給予適當(dāng)?shù)妮o助性藥物,降低復(fù)發(fā)率。
[Abstract]:Objective to investigate the surgical treatment and curative effect of laryngotracheal stenosis.Methods the clinical data of 48 patients with laryngotracheal stenosis from 2011 to 2015 were retrospectively analyzed.Among them, 6 cases refused surgery and 42 cases were included in follow-up analysis. 23 cases received CO2 laser scar resection under laryngoscope (2 cases received pingyangmycin injection and 10 cases received laryngotracheoplasty T-tube implantation and 2 cases received breast locking milk).T-tube reconstruction with clavicular periosteum flap was performed in 7 cases with end-to-end end-to-end anastomosis of trachea.The times of operation, the time of extubation, the swallowing and eating after operation, the activity tolerance were observed, and the curative effect of the operation was evaluated.Results there were 67 operations in 42 patients, 35 laser surgery, 18 tracheoplasty T tube implantation, 7 reconstruction T tube implantation with sternocleidomastoid clavicle periosteum flap.24 cases were cured by 7 times of T tube implantation with end-to-end anastomosis of trachea cuff, 3 cases underwent 3 operations and 5 cases underwent 4 times operation, 1 case had 5 operations, 1 case had 6 cases with long term tube and 2 cases died.The result of operation was ideal in 24 cases, basic ideal in 10 cases, ineffective in 8 cases. The successful rate of operation was 80.95%. 18 cases had final extubation, and the extubation rate was 7595%.After operation, 38 patients had different degrees of hoarseness, all patients had no dysphagia, and 3 patients with drinking water choking cough had decreased activity tolerance.Conclusion preoperative evaluation of the patient's condition, according to the degree of stenosis, location, length, the size of the stenosis plane, the patient's physical condition and whether the constitution of the scar, the best operation to reduce the number of operations, at the same time,Appropriate adjuvant drugs can also be given after the operation to reduce the recurrence rate.
【學(xué)位授予單位】：重慶醫(yī)科大學(xué)
【學(xué)位級別】：碩士
【學(xué)位授予年份】：2017
【分類號】：R767.91

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