喉气管狭窄课件

This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
手术治疗方法
①扩张：（气囊、记忆合金）。 ②气管袖状切除：端端吻合。 ③移植重建：自体移植，人工材料。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
喉气管狭窄治疗现状
福建医科大学附属协和医院 黄建民
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
术前评估
①原发病情况： ②临床表现： 呼吸困难程度 、声音质量 、 全身状况。 ③检查：（CT、MRI、电子喉镜）了解狭窄部 位、狭窄程度、周围组织情况。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
引言
喉气管狭窄是我科临床难题之一。导致狭 窄的原因复杂，手术治疗方法多样，但目前仍 无特效手段。改善喉气管通气是临床治疗的主 要目标。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
病变部位
★声门上占4.9%; ★声门占21.4% ★声门及声门下占24.1% ★声门下及气管占27.5% ★声门下及胸段气管占12.6%
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
扩张法
★间断扩张 ★持续扩张
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
喉气管重建术
主要目的：重建喉气管有效通气腔。 ★支架重建 ★上皮修复 ★腔道重建
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
移植重建 ※人工Leabharlann Baidu成材料
★机械强度、塑型优良 硅塑、高分子材料、记忆合金、羟基 磷灰石 ★组织兼容性好 ★ 经济简便
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
原因
①外伤：喉气管挫伤裂伤后(60.1%西安陈文弦)， 化学腐蚀伤(3 .4%)，烧伤，气管插管损伤(5.3%) ， 气管切开术后(13 .4%) 。小儿患者占18. 4 %(43/ 234)。 ②先天性疾病：先天性喉蹼、先天性喉鸣(喉软骨 软化症)、先天性小喉(新生儿声门前后径小于 5mm，后端横径小于3 mm)等; ③肿瘤(11.1%)：喉气管肿瘤术后; ④感染性疾病(3.4%)： :结核、梅毒、硬结病等特 异性感染，非特异性炎症如复发性多软骨炎。 ⑤其它：颈部放疗后(1.5%) ，或原因不明(1.5%) 。
移植重建 ※自体组织成型
★栅栏状喉气管重建术 ★环状软骨前后裂开加移植物 ★锁骨骨膜瓣修复术 ★胸骨舌骨肌蒂舌骨瓣转移术 ★肋软骨瓣移植成形术 ★颈阔肌皮瓣转移术 ★颈阔肌皮瓣加记忆合金成形术 ★喉成形、声门成形、激光腔内切除
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
分型
①Cotton法：是目前文献报道中使用较多的方法，分为四期： Ⅰ期:管腔阻塞<70%: Ⅱ期:管腔阻塞介于70~90%之间; Ⅲ期:管腔 阻塞>90 %，但仍有可辨别的管腔存在; Ⅳ期: 无管腔，声带不可 辨认。
②Grundfast法：分为四期：Ⅰ期:狭窄长度<-5mm，直径＞ 6mm ； Ⅱ期:狭窄长度5~10mm.直径6~4mm; Ⅲ期:狭窄长度 10~15mm.直径4~2mm; Ⅳ期:狭窄长度>15mm .直径<2mm。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
③McCaffrey法:：Ⅰ期:狭窄位于声门下或气管，长度＜1.0cm; Ⅱ期:限于声门下、环状软骨以上，长度>1.0cm，声门及气管不受 累; Ⅲ期:位于声门下且累及气管上端，但声门不受累；Ⅳ期:累及 声门且有一侧声带固定。
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
This year, my town construction work in the city, municipal government, municipal construction Bureau of the direct leadership and support, the Town party committee
袖状切除
颈段气管环形切除3 ~4cm，屈颈行气管 端端吻合。
超过4cm时,按Dedo等[所倡用的喉松解 法，将舌骨与甲状软骨间肌肉及韧带切断， 喉可下降2cm。
Mulliken报道了颈段气管游离方法，在 颈屈曲15~30度时经颈纵隔切口游离气管 前后壁，保留侧壁血管在内的软组织，可 切除气管4.5cm，如再开胸将右侧肺门游离 可增加1.4cm，总长度可达5.9cm。