Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee喉气管狭窄治疗现状福建医科大学附属协和医院黄建民Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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。Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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3mm)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%)。Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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%Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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。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。Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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。Thisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommitteeThisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommitteeThisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommitteeThisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommitteeThisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommitteeThisyear,mytownconstructionworkinthecity,municipalgovernment,municipalconstructionBureauofthedirectleadershipandsupport,theTownpartycommittee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。...
