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題名 | Use of the Silicone Tracheal T-Tube for Tracheostenosis or Tracheomalacia=矽質氣管T型管治療氣管狹窄或氣管軟化 |
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作者 | 劉洪彰; 王良順; 范徽智; 李毓芹; 盧崇正; 陳國翰; 黃敏雄; | 書刊名 | 中華醫學雜誌 |
卷期 | 58:3 1996.09[民85.09] |
頁次 | 頁190-197 |
分類號 | 416.899 |
關鍵詞 | 氣管T型管; 氣管狹窄; 氣管軟化; Tracheal T-tube; Tracheostenosis; Tracheomalacia; |
語文 | 英文(English) |
中文摘要 | 背景 氣管狹窄及氣管軟化是屬於困難而不易治癒的疾病,從病發到 重建往往須歷經複雜甚或冗長過程,在這段過渡時期,傳統上,必須借助於氣 切或氣插管治療,然而,無論是暫時性或是永久性,它們只能解決呼吸道阻塞 的問題,且仍然存在有許多的缺點,矽質氣管T型管的出現,提供了傳統氣切 或氣插管外另一種選擇性替代品。 方法 我們收集過去台北榮民總醫院因為氣管狹窄或氣管軟化接受過矽質氣管 T型管治療的病人,總共五個病人接受九次的矽質氣管T型管。有兩個病人是 因為氣管外傷而致病,有兩個病人是氣管內插管造成,而另一個病人則是因為 氣管內結核病導致氣管內狹窄,在追蹤期限內,兩個病人(40%)接受矽質氣管T 型管作為暫時性過渡治療,而另三位病人則接受氣管T型管作為永久性治療。 結果 所有的病人都在氣管T型管植入後得到解除呼吸道阻塞的實質幫助,同 時,在不考慮其中一位病人原有的疾病下,所有病人均可保留發聲功能,另外, 雖然氣管T型管可能因為疾病本身,肉芽組織的形成,以及黏液之阻塞造成必 須更換的缺點,它仍然可提供長期使用的優點。在五位病人中,有三位病人(60%) 有肉芽組織的生成並造成氣管的局部阻塞,其出現的平均時間是7.7個月,雷 射燒灼或是手術治療加上T形管更換是治療上的良好選擇。 結論 綜而言之,與其它的人工替代品比較,矽質T型管在特定的使用情況下, 是提供氣管狹窄或氣管軟化疾病的一種良好氣管內補綴器。 |
英文摘要 | Background. Tracheostenosis and tracheomalacia are trivial diseases. The conventional choice of managements with tracheostomy, either temporary or long-term usage, can only partially resolve the problems of airway obstruction. Silicone tracheal T-tube presents a substitute for it. Methods. We present 5 patients with tracheostenosis or tracheomalacia managed with nine procedures of long silicone Montgomery T-tube prosthesis between 1984 and 1994 in VGH-Taipei. The primary diagnosis included tracheal injury (2), postintubation tracheal stenosis (2), and stenosis due to endotracheal tuberculosis (1). Three patients received a long segmental T-tube for permanent endotracheal stenting and the other two patients used T-tube insertion for temporary stenting of the trachea for 7 and 11 months, respectively, with satisfactory results. Results. All patients got immediate benefit from the prosthesis in respiration with simple postoperative care. Two patients with temporary T-tube placement had it successfully removed in 7 and 11 months, respectively. Placement of the T-tube for subglottic stenosis also protected the function of phonation. The tracheal T-tube restored airway patency reliably with good long-term results and could be the preferred management of chronic upper airway obstructive disease not amenable to surgical repair. The most common complication was airway obstruction caused by either granulations or sticky mucoid substance. Three patients and six tubes (60%) developed granulation obstruction and the average duration of granuloma formation was 7.7 months. Laser phototherapy or surgical intervention, such as tracheoplasty, with change of the T-tube was carried out for granuloma obstruction. Conclusions. T-tube is a good endoprosthesis for tracheostenosis and tracheomalacia with minimal complication for cases of long tracheostenosis or complex tracheal injury. |
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