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目的 :研制喉全切除后气管造口植入式镍钛合金支架并临床应用 ,以期替代金属全喉套管预防术后气管造口狭窄。材料与方法 :直径为 0 .8mm的镍钛形状记忆合金钢丝 ,镍 5 0 %、钛 5 0 % ,支架形状为半圆形 (2 / 3)结构 ,其表面光滑 ,支架直径 18mm、19.5 mm、2 1mm三种规格。全喉切除 2 2例 ,选择大小合适的气管造口植入式镍钛合金支架 ,缝合固定于气管残段的第一和第二气管软骨环之间筋膜后 ,常规气管造口。术后气管造口敞开 ,免用金属全喉套管。结果 :术后造口 期愈合 19例 ;术后感染 3例。术后气管造口皮缘疤痕环形增生所至狭窄 6例 ,后经局麻下疤痕环切扩大造口治愈。术后无呼吸道症状 ,放疗后造口局部无组织坏死或感染。结论 :气管造口植入式镍钛合金支架临床应用安全、预防气管造口狭窄 ,可望替代金属全喉套管并预防气管造口狭窄。
Objective: To develop and clinical application of tracheostomy implantable nitinol stent after total laryngectomy, in order to replace metal throat casing to prevent postoperative tracheostoma stenosis. MATERIALS AND METHODS: Nickel-titanium shape memory alloy steel wire with a diameter of 0.8mm, 50% nickel and 50% titanium, the shape of the stent was a semicircle (2/3) structure with a smooth surface and a stent diameter of 18mm and 19.5mm , 2 1mm three kinds of specifications. Total laryngectomy in 22 cases, select the appropriate size of the tracheostomy implant Ni-Ti alloy stent, suture fixed in the tracheal stump between the first and second tracheal cartilage ring fascia, the conventional tracheostomy. Postoperative tracheostomy open, free metal throat casing. Results: 19 cases of postoperative ostomy healing; 3 cases of postoperative infection. Postoperative tracheostomy skin scarring ring hyperplasia to stenosis in 6 cases, followed by local anesthesia scar circumcision to expand stoma cure. No postoperative respiratory symptoms, local tissue necrosis or infection after stoma. Conclusion: The clinical application of tracheostomy implantable NiTi alloy stents is safe and prevents tracheostoma narrowing. It is expected to replace metal throat casing and prevent tracheostomy stenosis.