Idiopathische progressive subglottische Stenose – chirurgische Therapieoptionen

Zusammenfassung

Die idiopathische progressive subglottische Stenose ist gekennzeichnet durch eine langsam fortschreitende, narbige Verengung des subglottischen Atemwegs. Betroffen sind fast ausschließlich Frauen zwischen der 3. und 5. Lebensdekade. Oft werden die Symptome initial als Asthma bronchiale fehlgedeutet und die Patienten erst nach ausbleibendem Therapieerfolg endoskopisch untersucht. Die therapeutischen Optionen lassen sich in endoskopische und offen chirurgische Techniken unterteilen. Mikrolaryngoskopische Laserabtragung und Dilatation führen i. d. R. zu guten Kurzzeitergebnissen. Allerdings kommt es in einem Großteil der Patienten innerhalb kurzer Zeit zur erneuten Stenosierung. Offene chirurgische Korrekturen basieren auf dem Prinzip einer kompletten Resektion der erkrankten Atemwegsanteile. Bei fortgeschrittenen Stenosen muss eine solche Resektion mit unterschiedlichen Erweiterungstechniken kombiniert werden. Folgende Operationsverfahren sind je nach Schwere und Beschaffenheit der Stenose notwendig: klassische subglottische Resektionen nach Grillo, Krikoplastien mit dorsaler oder lateraler Mukosaplastik oder eine Kombination aus Resektion und Erweitungsplastik mit Rippenknorpelinterponaten. In erfahrenen Zentren können durch die Operation Erfolgsraten von über 95 % bei gleichzeitigem funktionellem Erhalt der Stimm- und Schluckfunktion erreicht werden.

Abstract

Idiopathic subglottic stenosis is a disease characterized by slow, progressive scarring and constriction of the subglottic airway. It almost always occurs in females between the 3rd and 5th decade of life. Symptoms are frequently misinterpreted as asthma and patients are referred for endoscopic evaluation only when asthma medications fail to alleviate their symptoms. Treatment options can be divided into endoscopic and open surgical techniques. Microlaryngoscopic scar reduction by laser followed by balloon dilation usually delivers good short-term results. However, the majority of patients will experience restenosis within a short period of time. Open surgical correction techniques are based on a complete removal of the affected airway segment. This must be combined with various extended resection techniques in patients with advanced stenosis. Depending on the extent and severity of the stenosis the following surgical techniques are required: standard cricotracheal resection (Grilloʼs technique), cricoplasty with dorsal and lateral mucosaplasty, or a combination of resection and enlargement techniques using rib cartilage grafts. In experienced centres, success rates of over 95 % are reported with good functional outcome of voice and deglutition.

Schlüsselwörter

Thoraxchirurgie - Stenose - chirurgische Technik

Key words

stenosis - thoracic surgery - surgical technique

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