The purpose of this study was to review the incidence, risks, management, and outcomes of nontumoral laryngeal stenosis after supracricoid partial laryngectomy (SCPL) in a case series of 376 consecutive SCPLs performed at 1 institution from 1975 to 1995 with a minimum of 3 years of follow-up. Post-SCPL nontumoral symptomatic laryngeal stenosis was defined as an inability to decannulate patients before the 60th postoperative day (group 1) or the development of dyspnea (in patients without local recurrence) after an initial period of prolonged, successful decannulation (group 2). Of 376 SCPLs performed, nontumoral symptomatic laryngeal stenosis developed in 14 (3.7%). There were 7 patients (1.85%) in group 1 and 7 patients (1.85%) in group 2. In univariate analysis, none of the following variables appeared to be statistically related to the risk of immediate stenosis (group 1): age, gender, comorbidity, diabetes mellitus, symptomatic gastroesophageal reflux, arteritis, preoperative radiotherapy, arytenoid cartilage disarticulation, type of reconstruction performed, and postoperative radiotherapy. A delayed laryngeal stenosis (group 2) was statistically more likely to occur if the reconstruction performed at the time of SCPL was a cricohyoidopexy (p = .01). Successful management of the laryngeal stenosis without permanent tracheostomy was achieved in 5 group 1 patients and 3 group 2 patients. We believe that stenosis in group 1 patients arose through technical error, whereas group 2 patients seemed to suffer from problems of healing, mainly cicatricial narrowing of the airway at the site of the cricohyoidal impaction, or pexis. As a result, whereas laryngeal stenosis in group 1 patients was usually more easily correctable through dilation, laser incision, or resection of redundant tissue or revision of the impaction, laryngeal stenosis in group 2 patients presented a more difficult and frustrating complication. The management and outcomes of these patients are presented.
这项研究的目的是回顾1975年至1995年在一家机构进行的连续376例超环喉部分喉切除术(SCPL)后非肿瘤性喉狭窄的发生率、风险、管理和结果,其中至少有3年的随访时间。术后SCPL非肿瘤性症状性喉狭窄被定义为术后60天前无法拔管的患者(第1组)或在初始较长时间的成功拔管后出现呼吸困难(无局部复发患者)(第2组)。在进行的376例SCPL中,非肿瘤性症状性喉狭窄发生在14例(3.7%)患者中。第1组有7例患者(1.85%),第2组有7例患者(1.85%)。在单变量分析中,以下变量似乎与即时狭窄风险(第1组)无统计学相关性:年龄、性别、合并疾病、糖尿病、症状性胃食管反流、动脉炎、术前放疗、杓软骨脱位、重建类型以及术后放疗。如果SCPL时进行的重建是环喉固定术(p = .01),则延迟性喉狭窄(第2组)更有可能发生。在第1组患者中,成功管理喉狭窄并避免永久气管切开术的有5例患者,第2组患者有3例。我们认为第1组患者的狭窄是由技术错误引起的,而第2组患者似乎遭受愈合问题,主要是环喉固定术的部位出现瘢痕性气道狭窄。因此,虽然第1组患者的喉狭窄通常更容易通过扩张、激光切开、冗余组织切除或修正固定来纠正,但第2组患者的喉狭窄则是一种更为困难和令人沮丧的并发症。这些患者的管理和结果被提出。