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
