背景:长段,IV级造口上气管狭窄罕见且难以治疗(Carpenter等人。,2022年[1])。IV级狭窄患者具有明显的生活质量障碍,因为他们是气管造口术依赖性和调音性的。通常需要进行开放气道手术以改善气管的通畅性,恢复病人的声音,以及在脱管化方面的进展(Abouyared等人。,2017年[2])。然而,并非所有患者都是前期开放手术的候选人(Abouyaredetal.,2017;Shamji,2018[2,3])。因此,重要的是制定和完善内镜干预措施,以改善这些患者的生活质量.
方法:我们描述了一种逐步的内窥镜方法,用于长段的再管,IV级造口上气管狭窄。简而言之,我们的方法利用狭窄的双重(近端和远端)可视化,然后将25号针头穿过狭窄,以确定合适的再插管轨迹.然后以相同的方式通过16号针,一根线穿过针头进入远端气道。一旦重新气道,最初的精确开口在Savary扩张器的电线上以Seldinger的方式逐渐扩大,然后进行气球扩张。最后,放置了造口上L型支架(改良的MontgomeryT型管)以降低再狭窄的风险(Edwards等人。,2023年[4])。
方法:一名39岁女性,有既往病史,对I型糖尿病和多物质滥用控制不佳,表现为气管造口术依赖和失音。她被诊断出患有长段,IV级造口上气管狭窄,最初接受了内窥镜再插管。这种干预恢复了她的声音,并允许在开放气道手术之前优化她的医疗条件。
结论:大多数患者的生活质量得到了显著改善,因为他们的声音通常在此过程后得到恢复。此外,最终需要进行开放气道手术的个人将获得额外的时间进行医疗优化.根据我们的经验,该手术是一种安全有效的方法,可扩展传统内镜下气道介入治疗IV级狭窄患者的实用性.
BACKGROUND: Long-segment, grade IV suprastomal tracheal stenosis is rare and difficult to treat (Carpenter et al., 2022 [1]). Patients with grade IV stenosis have significant quality of life impairments since they are tracheostomy dependent and aphonic. Open airway surgery is often needed to improve tracheal patency, restore the patient\'s voice, and progress towards decannulation (Abouyared et al., 2017 [2]). However, not all patients are candidates for upfront open surgery (Abouyared et al., 2017; Shamji, 2018 [2,3]). Therefore, it is important to develop and refine endoscopic interventions to improve quality of life for these patients.
METHODS: We describe a step-by-step endoscopic approach to the recannulation of long-segment, grade IV suprastomal tracheal stenosis. Briefly, our approach utilizes dual (proximal & distal) visualization of the stenosis prior to passing a 25 gauge needle through the stenosis to identify the proper trajectory for recannulation. Then a 16 gauge needle is passed in the same manner, and a wire is placed through the needle and into the distal airway. Once the airway is recannulated, the initial pinpoint opening is gradually widened in Seldinger fashion over the wire with Savary dilators followed by balloon dilation. Finally, a suprastomal L-stent (modified Montgomery T-Tube) is placed to reduce the risk of restenosis (Edwards et al., 2023 [4]).
METHODS: A 39-year-old woman with a past medical history significant for poorly controlled type I diabetes mellitus and polysubstance abuse presented with tracheostomy dependence and aphonia. She was diagnosed with a long-segment, grade IV suprastomal tracheal stenosis and initially underwent endoscopic recannulation. This intervention restored her voice and allowed for optimization of her medical conditions before open airway surgery.
CONCLUSIONS: Most patients experience a significant improvement in their quality of life as their voice is typically restored following this procedure. Additionally, individuals who eventually require open airway surgery gain additional time for medical optimization. In our experience, this procedure represents a safe and effective means of extending the utility of traditional endoscopic airway interventions for the management of patients with grade IV stenosis.