KHẢO SÁT TÌNH HÌNH ĐIỀU TRỊ SẸO HẸP THANH – KHÍ QUẢN TẠI BỆNH VIỆN ĐẠI HỌC Y DƯỢC TP. HỒ CHÍ MINH TỪ 2019 ĐẾN 2024

Abstract

Background: Laryngotracheal stenosis (LTS) in adults has multiple causes, the most common being prolonged endotracheal intubation or tracheostomy. Other causes include laryngeal-tracheal surgery, head and neck trauma, and infections. Accurate assessment of scar characteristics and choosing the correct surgical technique in each clinical scenario are essential for successful outcomes. Treatment aims to restore airway patency and preserve vocal function.

Objectives: to describe clinical and paraclinical characteristics of laryngotracheal stenosis and evaluate the effectiveness of surgery treatment at University Medical Center Ho Chi Minh City from 2019 to 2024.

Methods: A retrospective study was conducted on 42 cases of LTS treated from January 2019 to July 2024. Patients were evaluated clinically through detailed history and previous records. The correlation between endoscopy, CT-scan, and intraoperative findings on stenosis characteristics was analyzed. Postoperative outcomes were clinically assessed for ventilation and voice quality.

Results: The study included 42 patients, 10 with glottic stenosis (GS) and 32 with subglottic tracheal stenosis (SGTS). The male-to-female ratio was equal, with the majority in working age (youngest 18 years old and oldest 81 years old). The most common cause was prolonged endotracheal intubation or tracheostomy (61.9%). Isolated tracheal stenosis accounted for 50%, with firm stenosis [1] (fibrosis, chondrification/ossification) being the most common type (61.9%). The degree of narrow stenosis is mainly Cohen [2] II in GS (40%) and Myer-Cotton [3] III in SGTS (50%). Most patients had normal vocal fold mobility (78.6%). Endoscopy accurately assessed stenosis severity in 100% of GS and 93.8% of SGTS cases; CT-scan achieved 100% accuracy for SGTS. CT-scan measurements of stenosis diameter and length significantly correlated with surgical findings (r = 0.946 and r = 0.994; p < 0.01). Treatment methods included tracheal resection and anastomosis, stent placement, and endoscopy. The decannulation rate was 73.8%, and 71.4% of patients had normal voice post-treatment, with 28.6% experiencing voice disorders.

Conclusions: Endoscopy and CT-scan are valuable tools for diagnosis and treatment planning in tracheal stenosis. Treatment choices depend on stenosis severity, comorbidities, and postoperative care capacity. Outcomes indicate improved airway patency and voice preservation for patients.