Laryngotracheal resection and reconstruction for subglottic tracheal stenosis
Objective: To study the effects of laryngotracheal resection and reconstruction for benign subglottic laryngotracheal stenosis(LTS) in the adult. Methods: The charts of 32 patients who underwent surgical treatment for subglottic laryngotracheal stenosis between January 2006 and December 2012 were reviewed retrospectively. Surgical procedures, effects and complications were analyzed. Result: The causes of LTS included cervical blunt injury 14 cases (43.75%) , post-intubation 12 cases (37.5%), posttracheostomy 2 cases (6.25%), pharyngolaryngeal scald one case (3.13%), idiopathic one case (3.13%), relapsing polychondritis one case (3.13%), and postthyriodectomy for huge nodular goiter one case (3.13%). There were 8(25%) cases of grade III and 24(75%) cases of grade IV.Decanulation was achieved successfully in 27 (84.4%) patients, including stenosis resection and end-end anastomosis with T tube implantation 11 cases, tracheo-esophageal fistula repair plus stenosis resection and end-end anastomosis with T tube implantation 2 cases，stenosis resection and end-end anastomosis 13 cases，tracheo-esophageal fistula repair plus stenosis resection and end-end anastomosis one case. Repair of tracheo-esophageal fistula was done successfully in all cases. The resection length of stenosis was 1.5cm(0.5-3.0cm) in cases with T tube implantation, and 2.5cm（1.5-3.5cm）in those without T tube implantation. The postoperative complication included pulmonary infection, which was occurred postoperatively in 3 patients(9.39%), and subcutaneous emphysema in the neck was in 4 cases(12.5%). One patient of relapsing polychondritis with subglottic and tracheal stenosis died of tension pneumothorax and tension pneumoperitoneum. Four patients (12.5%) presented with restenosis. Conclusion: post-intubationy tracheostomy injury and cervical blunt injury are the leading causes of LTS. Cricotracheal resection and thyrotracheal anastomosis along with laryngotracheal reconstruction has an excellent outcome for server subglottic stenosis. Laryngotracheal stenosis with concomitant tracheo-esophageal fistula can primaryly be repaired successfully with cricotracheal resection and thyrotracheal anastomosis along with laryngotracheal reconstruction. Frequent complications were pulmonary infection, neck subcutaneous emphysema and restenosis. The bilateral tension pneumothorax and tension pneumoperitoneum are rarely fatal complication.
Key Words: subglottic laryngotracheal stenosis, laryngotracheal resection, reconstruction