T型管在成人颈段气管狭窄个体化气道重建中的应用

Application of a T-tube in Individualized Airway Reconstruction for Adult Cervical Tracheal Stenosis

摘要:

目的 探讨T型管在成人颈段气管狭窄个体化气道重建中的应用价值及拔管结局。方法 回顾性分析2023年6月至2025年7月我科收治的11例成人颈段气管狭窄患者的临床资料，全部患者均行颈段气管成形术，并在此基础上使用T型管作为开放气道重建后瘢痕重塑期的支撑，依据软骨支架完整性、管腔内病变性质及瘢痕稳定性，个体化决定是否同期附加狭窄段切除端端吻合、气管内肉芽或病损切除等术式。主要结局指标为拔管成功率。结果 11例中男10例，女1例；年龄25～60岁，平均（46.0±11.2）岁。病因为气管切开术后8例（72.7%）、气管插管后2例（18.2%）、颈部外伤后1例（9.1%），医源性狭窄合计10例（90.9%）。同期附加术式：狭窄段切除端端吻合7例（63.6%），气管内肉芽或病损切除3例（27.3%），未附加其他气道重建术式2例（18.2%），其中例8同期行狭窄段切除端端吻合及气管内病损切除。T型管留置时间6～12个月，中位数12（Q1 7，Q3 12）个月，11例均成功拔管，拔管成功率100%（11/11，95%CI 71.5%～100%）；带管期间无并发症发生。拔管后随访6～20个月，未见再狭窄及需再次手术者。结论 在成人颈段气管狭窄患者中，T型管作为瘢痕重塑期支撑并个体化联合其他术式的综合气道重建策略可获得较高的拔管成功率，仍需多中心前瞻性研究验证。

Abstract:

Objective To investigate the clinical value of the T-tube (Montgomery T-tube) in individualized airway reconstruction for adult cervical tracheal stenosis and its decannulation outcomes. Methods  The clinical data of 11 adult patients with cervical tracheal stenosis treated in our department between June 2023 and July 2025 were retrospectively analyzed. All patients underwent cervical tracheoplasty, on the basis of which the T-tube was used to provide support during the scar-remodeling phase after open airway reconstruction. Individualized decisions on whether to perform concomitant procedures, including segmental resection of the stenotic segment with end-to-end anastomosis or excision of intratracheal granulation tissue or lesions, were made based on the integrity of the cartilaginous framework, the nature of the intraluminal lesion, and scar stability. The primary outcome measure was the decannulation success rate. Results  Among the 11 patients, 10 were male and 1 was female, with an age range of 25 to 60 years [mean (46.0 ± 11.2) years]. The etiologies were post-tracheostomy stenosis in 8 patients (72.7%), post-intubation stenosis in 2 patients (18.2%), and post-cervical-trauma stenosis in 1 patient (9.1%), with iatrogenic stenosis accounting for 10 patients (90.9%). Concomitant procedures comprised segmental resection with end-to-end anastomosis in 7 patients (63.6%) and excision of intratracheal granulation tissue or lesions in 3 patients (27.3%), whereas 2 patients (18.2%) underwent no additional airway reconstruction; notably, patient 8 underwent both segmental resection with end-to-end anastomosis and excision of intratracheal lesions simultaneously. The T-tube indwelling time ranged from 6 to 12 months [median 12 (Q1 7, Q3 12) months]. Successful decannulation was achieved in all 11 patients, yielding a decannulation success rate of 100% (11/11; 95% CI, 71.5%–100%), and no complications occurred during the indwelling period. During a post-decannulation follow-up of 6 to 20 months, no restenosis or requirement for reoperation was observed. Conclusion  In adult patients with cervical tracheal stenosis, a comprehensive airway reconstruction strategy employing the T-tube as support during the scar-remodeling phase, combined with individualized concomitant procedures, can achieve a high decannulation success rate. Further multi-center prospective studies are needed to verify this.