以喉重建術及T形管短期支墊治療喉鈍傷─病例報告

Laryngeal Reconstruction with Short-Termed Stenting for Acute Blunt Laryngeal Injury - Case Report

邱碩堯(Shuo-Yao Chiu) ； 李憲彥(Shiann-Yann Lee)

《中華民國耳鼻喉科醫學會雜誌》 31卷3期 (1996/06) Pp. 233-240

https://doi.org/10.6286/1996.31.3.233

摘要

本病例為47歲男性機車騎士，車禍後被道至急診。因有漸進加國性之咳血、嗄聲及喘鳴，臆斷為喉鈍傷併呼吸窘迫而接受緊急氣管切開術。經光纖內視鏡及電腦斷層立體影像重組檢查後確定傷害嚴重程度為第四級，於受傷後7天進行喉重建及T形管支墊術。術後8週拔管，追蹤迄今已逾7個月，呼吸完全正常，嗓音沙啞但清晰可辨。因屬稀少病例且處理方式特殊，故提出報告以供參考。

關鍵字

喉鈍傷 ； 喉重建 ； 立體影像重組

並列摘要

We encountered a 47-year-old motorcyclist surviving a traffic accident presenting with hemoptysis, hoarsensee, and progressive stridor. After emergency tracheotomy, fiberoptic endoscopy revealeld postcricoid mucosa laceration, bruise in posterior pharyngeal wall, and diffuse laryngeal edema, which were compatible with padded dash syndrome. Besides esophageal perforation was excluded by Gastrografin esophagogram. Conventional CT scan showed fractures in bilateral thyroid ala, while 3-D image reconstruction clearly demonstrated H-shape fracture line around the thyroid notch. The latter proved to predict the operative finding much deter.
Laryngeal reconstruction was performed on the 7th day follows: (1) Laryngofissure and repair of mucosa and cartilage; (2) Mucosa tenting sutures to prevent recollapse of lumen; (3) Montgomery silicone T-tube of 13 mm outer diameter used as stent; (4) Closure of skin layer only, leaving the underlying soft tissue layer unapproximated.
He was decannulated 8 weeks later and the follow-up thereafter has been over 7 months. The airway patency was fully adequate and categorized as “good”. The voice was hoarse but readily intelligible and of moderate volume, categorized as “fair”. The diagnostic facilities, operation timing and methods, together with the options of stents were discussed elaboratively in the text.

並列關鍵字

blunt laryngeal injury ； laryngeal reconstruction ； 3-D image reconstruction