乳幼児の喉頭・気管狭窄の臨床的検討

Abstract

This paper describes the safe management of laryngotracheal stenosis in infancy and childhood. We treated 10 such patients over a 12 year period at the Kochi Medical School Hospital: 4 with congenital stenosis, 4 immature neonates on ventilators and 2 others on ventilators (one viral croup and one drowning). In 6 of these 10 patients (4 immature cases and 2 others), the stenosis was a result of prolonged intubation.With 7 patients the initial treatment was the application of a T-tube stent. Of these 7 patients, 2 of the treatments were successful, one patient died and the other four patients were treated using the trough method.With a total of 6 patients (including the 4 patients who initially had T-tube stents), the trough method was employed. Of these 6 patients, 5 of the treatments were successful: of these, 4 patients had composite auricular free grafts performed and one did not require it.During the treatments, 3 patients died, the causes of death were not related to the treatments.Two died of tracheomalacia and one of leukemia.Although it took an average of 28 months to complete, we recommend the trough method with the use of composite auricular free grafts as the safest and most reliable laryngotracheal reconstruction for infants and children due to the low success rate of initial using T-tube stents.