Zusammenfassung
Hintergrund: Die Behandlung der subglottischen Stenose kann in Form einer laryngotrachealen Erweiterungsoperation oder einer cricotrachealen Resektion erfolgen. Patienten und Methoden: In einer retrospektiven Untersuchung wurden die Erfahrungen mit der laryngotrachealen Erweiterung isolierter subglottischer Stenosen bei 37 Patienten (Alter: 3 - 78 Jahre; Stenosegrad: 20 × Grad II, 13 × Grad III, 4 × Grad IV) über einen Zeitraum von 30 Jahren erfasst. Ergebnisse: Eine erfolgreiche Erweiterung des subglottischen Raumes (postoperativer Endoskopiebefund einer Stenose von < 30 %) war bei 33 der 37 Patienten (89,2 %) möglich, erforderte jedoch bei 5 Patienten Revisionsoperationen der laryngotrachealen Erweiterung und bei 22 Patienten waren endoskopische Granulationsgewebsabtragungen notwendig. Die erfolgreiche subglottische Erweiterung konnte bei allen Patienten mit einer Grad-II-Stenose (20/20), bei 11 der 13 Patienten mit einer Grad-III-Stenose und bei 3 der 4 Patienten mit einer Grad-IV-Stenose erreicht werden. Bei einem Kind trat eine akzidentelle Dekanülierung auf, die in Folge einer Asphyxie zu einem apallischen Syndrom führte. Schlussfolgerungen: Wenngleich die laryngotracheale Erweiterungsoperation große Erfahrung benötigt, können mit dieser Behandlungstechnik subglottische Stenosen < 90 % sehr erfolgreich erweitert werden. Auch bei hochgradigen subglottischen Stenosen (> 90 %) kann diese Operationstechnik zur Anwendung kommen insbesondere in Situationen, in denen eine fehlende Mobilisierbarkeit der Trachea aufgrund von narbigen Fixierungen vorliegt oder eine zu ausgedehnte cricotracheale Stenose eine cricotracheale Resektion verhindert.
Abstract
Background: Severe subglottic stenosis is a difficult condition to manage. It can be treated by laryngotracheal reconstruction or cricotracheal resection. Patients and Methods: In this retrospective study the experiences for treatment of isolated subglottic stenosis in 37 patients (age: 3 - 78 years; stenosis grading: 20 × grade II, 13 × grade III, and 4 × grade IV) by laryngotracheal reconstruction in a 30-years experience are presented. Results: In 33 out of 37 patients (89.2 %) a sufficient subglottic patency (postoperative endoscopic finding: stenosis less than 30 %) was achieved by laryngotracheal reconstruction. However, 5 patients of this series had required revision of laryngotracheal recontruction and in 22 patients endoscopic removal of granulation tissue had been performed. Sufficient widening of the subglottic space had been possible in all grade II stenosis (20/20), in 11 out of 13 patients with grade III stenosis, and in 3 out of 4 patients with grade IV stenosis. In one child an accidental decannulation occurred and due to asphyxia an apallic syndrome developed. Conclusions: Even through laryngotracheal reconstruction is a demanding surgical technique requiring great experience it is an effective option for treatment of subglottic stenosis less than 90 %. For severe subglottic stenosis (> 90 %) treatment by laryngotracheal reconstruction is possible and should be considered if mobilisation of the trachea by scar tissue is suited to be worse or to extended cricotracheal stenosis is present, both being not good candidates for cricotracheal resection.
Schlüsselwörter
subglottische Stenose - Langzeitintubation - Chirurgie - laryngotracheale Erweiterung - cricotracheale Resektion
Key words
subglottic stenosis - long-term intubation - surgery - laryngotracheal reconstruction - cricotracheal reconstruction
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Prof. Dr. Heinrich Iro
Hals-Nasen-Ohrenklinik, Kopf- und Halschirurgie
Friedrich-Alexander-Universität Erlangen-Nürnberg
Waldstraße 1
91054 Erlangen
Email: heinrich.iro@hno.imed.uni-erlangen.de
