성문하 확장과 단단문합술을 동시에 이용한 기관 및 성문하 협착증 치험 2례

정동학,김병훈,조정일,김영진 대한기관식도과학회 1997 大韓氣管食道科學會誌 Vol.3 No.1

Laryngotracheal stenosis is one of the most troublesome diseases in the Em field. Subglottic stenosis can be treated by a cricoid augmentation with rib cartilage. In case of tracheal stenosis, the treatment of choice is by tracheal end-to-end anastomosis after resection of the stenotic site. However, in case of subglottic stenosis combined with tracheal stenosis, it is hard to manage. Even though several methods(such as thyrotracheal anastomosis) have been tried, they have some limitations too much excision of normal trachea and too much pulling up of the trachea after resection of the stenotic lesion. The authors have managed two cases of laryngotracheal stenosis as an anterior and posterior subglottic augmentation with an autologous cartilage graft and laryngotracheal anastomosis. The first few weeks after the operation, we could do a decannulation successfully, but in one case the patient developed restenosis. Even though one case was unsuccessful, the authors believe that this method could be used in the treatment of laryngotracheal stenosis.

Long-Term Results of Endoscopic Dilatation for Tracheal and Subglottic Stenosis

오솔길,박기남,이승원 대한이비인후과학회 2014 Clinical and Experimental Otorhinolaryngology Vol.7 No.4

Objectives. The purpose of this study was to assess the long-term results of endoscopic dilatation of airway stenosis and to evaluate predictive factors for favorable results. Methods. Fifty-four patients with tracheal and subglottic stenosis who underwent endoscopic dilatation with at least 12 months follow-up were enrolled in this study. We evaluated predictive factors for final treatment outcome such as ste- nosis length, location, characteristics, procedure type, and the severity of stenosis. Results. The final outcome of endoscopic dilatation showed a cure rate of 40.7%, improvement rate of 46.3%, and failure rate of 13.0%. Patients with mild stenosis or a shorter stenotic segment and those who underwent a touch-up proce- dure following tracheal resection with end-to-end anastomosis showed better outcomes. The cure rate of endoscopic dilatation for patients with shorter mild stenosis was 72.2%. Conclusion. Endoscopic dilatation may be a primary treatment modality for patients with airway stenosis characterized by mild severity and a short stenotic segment.

Respiratory insufficiency and dynamic hyperinflation after rigid bronchoscopy in a patient with relapsing polychondritis -a case report-

안현주,김지애,양미경 대한마취통증의학회 2013 Korean Journal of Anesthesiology Vol.65 No.6

Relapsing polychondritis (RP) is an uncommon disease that is characterized by inflammation and destruction of cartilaginous structures. When tracheobronchial tree is involved, respiratory obstructive symptoms can occur. A 35-year-old man, with a previous diagnosis of RP, was scheduled for rigid bronchoscopy to relieve dyspnea, caused by subglottic stenosis. After laser splitting of the subglottic web, the spontaneous respiration of the patient was insufficient, and hypercarbia developed progressively even with assisted ventilation. After 20 minutes of aggressive hyperventilation to reduce end-tidal CO2 level, sudden extreme tachycardia and hypotension developed. Ventilation rate was reduced and prolonged expiration time was allowed to alleviate a near-tampon status from dynamic hyperinflation. After the hemodynamic status was stabilized, the patient was transferred to the ICU for mechanical ventilation. He received ICU care for 30 days, and now, he was on supportive care on a ward, considering Y stent insertion to prevent luminal collapse from tracheobronchomalacia.

Airway management using laryngeal mask airway in insertion of the Montgomery tracheal tube for subglottic stenosis -A case report-

박정선,권영석,이상석,윤준현,김동원 대한마취통증의학회 2010 Korean Journal of Anesthesiology Vol.59 No.-

The Montgomery tracheal tube (T-tube) is a device used as a combined tracheal stent and airway after laryngotracheoplasty for patients with tracheal stenosis. This device can present various challenges to anesthesiologists during its placement, including the potential for acute loss of the airway, inadequate administration of inhalation agents, and inadequacy of controlled mechanical ventilation. The present case of successful airway management used a laryngeal mask airway under total intravenous anesthesia with propofol and remifentanil in the insertion of a Montgomery T-tube in a tracheal resection and thyrotracheal anastomosis because of severe subglottic stenosis.

CHARGE 증후군 환자에서 호흡기 문제에 관한 분석: 단일 기관 연구

송상미 ( Sangmi Song ),박미란 ( Mi Ran Park ),김지현 ( Jihyun Kim ),최연아 ( Youn Ah Choi ),허준 ( Jinyoung Song ),강이석 ( June Huh ),정만기 ( I Seok Kang ),정한신 ( Man Ki Chung ),손영익 ( Han Sin Jeong ),안강모 ( Young Ik Son 대한천식알레르기학회 2014 Allergy Asthma & Respiratory Disease Vol.2 No.1

Purpose: CHARGE syndrome consists of multiple malformation including coloboma, heart defect, choanal atresia, growth or developmental retardation, genital anomalies, and ear anomalies. The aim of this study was to evaluate the respiratory problems in children with CHARGE syndrome. Methods: Out of 9 patients with CHARGE syndrome, medical records from 8 patients showing respiratory distress or respiratory failure were retrospectively reviewed. We investigated the causes of respiratory problems by physical examination, endoscopy, echocardiogram, computed tomography, rigid bronchoscopy, swallowing test, and 24-hour impedence monitoring. esults: Five patients required endotracheal intubation soon after birth due to bilateral choanal atresia (n=2) and congenital heart diseases (n=3). Three patients were intubated within a month because of surgery for complex heart diseases (n=2) or recurrent apnea (n=1). Tracheostomy was performed in 3 patients who showed primary or secondary subglottic stenosis. Among 8 patients who had aspiration or respiratory distress after feeding, cricopharyngeal incoordination and gastroesophageal reflux disease were found in 7 and 2 children, respectively. One patient died of aspiration during oral feeding. Conclusion: Patients with CHARGE syndrome manifest respiratory distress or failure due to various causes including congenital anomaly in the airway, cardiac anomaly, neurologic or gastrointestinal problems. Therefore, pediatricians should be alert to the respiratory symptoms and signs in CHARGE syndrome and take active intervention from the birth to improve their long-term prognosis. (Allergy Asthma Respir Dis 2014;2:70-74)

성문하협착증에서 윤상연골절개 및 윤상연골 후벽 늑연골 이식술과 T-tube stenting

손진호,Sohn, Jin-Ho 대한기관식도과학회 1999 大韓氣管食道科學會誌 Vol.5 No.2

OBJECTIVES : To determine the results of posterior cricoid split with costal cartilage graft in the treatment of moderate and severe subglottic stenosis in adults, and to assess the effect of T-tube as a stent in this surgery. PATIENTS AND METHODS : Four adults with moderate and severe subglottic stenosis who underwent posterior cricoid split with costal cartilage graft from 1994 to 1995. Three patients were male and one was female. All of the patients had acquired subglottic stenosis, 2 of whom had a bilateral vocal folds paralysis. The surgical procedure we used included a cricoid lamina split with costal cartilage grafting and T-tube stenting. Arytenoidectomy was a added in 2 patients with bilateral vocal folds paralysis. RESULTS : Three of the 4 patients underwent decannulation, and 1 is still undergoing treatment. 3 patients who underwent decannulation demonstrated marked improvement in their symptoms of airway obstruction and good postoperative voice quality. CONCLUSIONS : The posterior cricoidotomy lumen augmentation with costal cartilage grafting is a safe and effective technique for the treatment of moderate and severe subglottic stenosis in adults and T-tube is a good alternative stenting material for this procedure.

단단문합술로 치료한 후두기관 협착 4례

태경,홍동균,이형석,박철원,Tae, Kyung,Hong, Dong-Kyun,Lee, Hyung-Seok,Park, Chul-Won 대한기관식도과학회 2001 大韓氣管食道科學會誌 Vol.7 No.1

Management of laryngotracheal stenosis remains one of the most challenging problems facing the otolaryngologist. The key to success is to obtain adequate rigid circular support with normal mucosal lining. Four Patients with laryngotracheal stenosis were surgically treated in our institution in 2000. All the patients were male adults. The cause of stenosis were longterm or repeated endotracheal intubation and tracheostomy in our patients. All patients were successfully decannulated following segmental resection of the stenotic portion including the anterior arch of the cricoid cartilage and end-to-end anastomosis after suprahyoid laryngeal release. The time between treatment and decannulation was just one day in three patients. These results suggest the Possibility of early decannulation even if the cricoid cartilage was partially resected. It is better to prevent laryngotracheal stenosis rather than to treat it once it has occurred.

성인의 성문하협착증의 치료

최건,민헌기,정광윤,최종욱,Choi, Geon,Min, Heon-Ki,Jung, Kwang-Yoon,Choi, Jong-Ouck 대한기관식도과학회 1995 大韓氣管食道科學會誌 Vol.1 No.1

The experience with treatment of acquired subglottic stenosis in 20 adults is reviewed. Nine of the 20 patients (45%) had opeated by other institues before treatment. Causes of the disease were 10(50%) of blunt neck trauama and 10(50%) of prolonged intubation. The most common associated airway diseases were nine patients (45%) of bilateral vocal cord fixations. Twelve patients (60%) underwent anterior cartilage grafts, five patients (25%) had anterior and posterior cartilage grafts and three patients (15%) had end to end anastomosis according to the severity of cricoid deformities and mucosal defects. Associated procedures were 9 patients (45%) of arytenoidectomy. Thirteen of 20 patients (65%) have been decannulated. Fe-male group was significantly higher decannulation rate than male group (p=0.0074). Decannulation rates were decreased from anterior cartilage graft group to anterior and posterior cartilage grafts group and to end to end anastomosis group (p= 0.00247), this finding suggested the patients with severe cricoid deformitiy were higher likely hood of failure because we selected the method used in this study according to the severity of cricoid deformities and mucosal defects. Our results support the more aggressive treatment is indicated for subglottic stenosis in adults.

원인을 알 수 없는 무증상 성문하협착 전자간증 산모에서 예기치 못한 어려운 기관 내 삽관 - 증례 보고 -

한상지 대한마취통증의학회 2007 Anesthesia and pain medicine Vol.2 No.4

Subglottic stenosis can be caused by various etiology such as idiopathic, infectious disease, trauma from previous prolonged intubation, airway surgery, external blunt trauma, radiaton, or inhalation burn. Although extremely rare, subglottic stenosis may be present in pregnancy and engender a complex and technically challenging dilemma for anesthesiologist as how to evaluate and best manage these patients. A 36-year-old parturient was scheduled for Cesarean section. When most of the vocal cords were exposed clearly by laryngoscopy after injection of thiopental sodium & succinylcholine, the 7.0 mm internal diameter (ID) endotracheal tube could not be advanced below the level of the vocal cords because of resistance. So, intubation was re-attempted several times after oxygenation by mask with smaller tubes. Finally, a 6.0 mm ID cuffed tube was passed successfully through the vocal cords, and secured in place. because of the unexpected difficulties in intubation, an otolaryngologist was consulted to examine the larynx with a microscope. We present an unexpected case of the difficult endotracheal intubation caused by a unrecognized subglottic stenosis in a preeclamptic who underwent the induction of general anesthesia for Cesarean section.

기관 식도루를 동반한 선천성 후두 성문하부 협착증-1 부검례-

김인숙,권태정,이동화 대한병리학회 1989 Journal of Pathology and Translational Medicine Vol.23 No.3