78. Kết quả của phẫu thuật nội soi điều trị sẹo hẹp thanh quản ở người lớn: Tổng quan y văn
Nội dung chính của bài viết
Tóm tắt
Đánh giá hiệu quả của phẫu thuật nội soi điều trị sẹo hẹp thanh quản ở đối tượng người lớn. Nghiên cứu tổng quan luận điểm bao gồm các nghiên cứu từ nguồn cơ sở dữ liệu trang thông tin điện tử Pubmed, Google scholar. Tiêu chí lựa chọn là những nghiên cứu sử dụng các phương pháp phẫu thuật nội soi trong điều trị sẹo hẹp thanh quản. Chúng tôi tìm được 26 bài báo phù hợp với các tiêu chuẩn lựa chọn liên quan đến 1182 bệnh nhân được điều trị bằng các phương pháp như cắt sẹo hẹp, nong cơ học, tiêm corticoid, chấm Mitomycin, đặt vật liệu/stent, tạo vạt. Chúng tôi tiến hành phân tích về đặc điểm và thời gian theo dõi, tỷ lệ thuyên giảm, tỷ lệ tái phát và tỷ lệ chuyển phẫu thuật mở khi điều trị bằng các phương pháp trên.Mặc dù còn nhiều tranh luận, bài tổng quan chỉ ra rằng phẫu thuật nội soi trong điều trị sẹo hẹp thanh quản mang lại hiệu quả cao với tỷ lệ thuyên giảm từ 68,75% đến 100%.
Chi tiết bài viết
Từ khóa
Sẹo hẹp thanh quản, phẫu thuật nội soi, kết quả điều trị
Tài liệu tham khảo
1. Almanzar A, Danckers M. Laryngotracheal Stenosis. In: StatPearls. StatPearls Publishing; 2025. Accessed June 27, 2025. http://www.ncbi.nlm.nih.gov/books/NBK554561/.
2. Laryngeal Stenosis: Practice Essentials, Problem, Epidemiology. Published online November 28, 2023. Accessed June 4, 2024. https://emedicine.medscape.com/article/867177-overview#a1?form=fpf.
3. Anh TH, Anh TT, Duy PQ, Dung NTN. Khảo sát các phương pháp điều trị sẹo hẹp thanh - khí quản tại Bệnh viện Tai mũi họng TP Hồ Chí Minh. VMJ. 2023; 529(1). doi:10.51298/vmj.v529i1.6298.
4. Yamamoto K, Kojima F, Tomiyama K ichi, Nakamura T, Hayashino Y. Meta-Analysis of Therapeutic Procedures for Acquired Subglottic Stenosis in Adults. The Annals of Thoracic Surgery. 2011; 91(6): 1747-1753. doi:10.1016/j.athoracsur.2011.02.071.
5. Suzuki H, Tanifuji T, Hasegawa I, Fukunaga T. A forensic autopsy case of death from laryngeal stenosis due to a late complication of radiotherapy. Legal Medicine. 2016; 20: 15-17. doi:10.1016/j.legalmed.2016.03.004.
6. Nair S, Nilakantan A, Sood A, Gupta A, Gupta A. Challenges in the Management of Laryngeal Stenosis. Indian J Otolaryngol Head Neck Surg. 2016; 68(3): 294-299. doi:10.1007/s12070-015-0936-2.
7. Pan DR, Rosow DE. Office-based corticosteroid injections as adjuvant therapy for subglottic stenosis. Laryngoscope Investig Oto. 2019; 4(4): 414-419. doi:10.1002/lio2.284.
8. Lucioni M, Bertolin A, Lionello M, et al. Transoral laser microsurgery for managing laryngeal stenosis after reconstructive partial laryngectomies. The Laryngoscope. 2017; 127(2): 359-365. doi:10.1002/lary.26056.
9. Hseu AF, Benninger MS, Haffey TM, Lorenz R. Subglottic stenosis: A ten-year review of treatment outcomes. The Laryngoscope. 2014; 124(3): 736-741. doi:10.1002/lary.24410.
10. Zhao J, Li J, Guo H. A Novel Keel for Treatment of Anterior Glottic Webs. American Journal of Otolaryngology and Head and Neck Surgery. 2019; 2(9). Accessed June 28, 2025. https://www.remedypublications.com/american-journal-of-otolaryngology-and-head-and-neck-surgery-abstract.php?aid=5249.
11. Neevel AJ, Schuman AD, Morrison RJ, Hogikyan ND, Kupfer RA. Serial Intralesional Steroid Injection for Subglottic Stenosis: Systemic Side Effects and Impact on Surgery-Free Interval. OTO Open. 2021; 5(4): 2473974X211054842. doi:10.1177/2473974X211054842.
12. Jiam NT, Dwyer CD, Rosen CA. Awake Laser Laryngeal Stenosis Surgery. The Laryngoscope. 2021; 131(5): E1633-E1637. doi:10.1002/lary.29295.
13. Maldonado F, Loiselle A, DePew ZS, et al. Idiopathic subglottic stenosis: An evolving therapeutic algorithm: Idiopathic Subglottic Stenosis. The Laryngoscope. 2014; 124(2): 498-503. doi:10.1002/lary.24287.
14. Wehbi N, Gleadhill CME, Ahmadian D, Skirko JR, Yip HT. In-office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple etiologies. World J Otorhinolaryngol Head Neck Surg. 2024; 11(1): 17-22. doi:10.1002/wjo2.159.
15. Hoffman MR, Coughlin AR, Dailey SH. Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. The Laryngoscope. 2017; 127(11): 2475-2481. doi:10.1002/lary.26682.
16. Franco RA, Husain I, Reder L, Paddle P. Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. The Laryngoscope. 2018; 128(3): 610-617. doi:10.1002/lary.26874.
17. Hoffman MR, Francis DO, Mai JP, Dailey SH. Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects. Ann Otol Rhinol Laryngol. 2020; 129(4): 361-368. doi:10.1177/0003489419889066.
18. Fijolek J, Wiatr E, Gawryluk D, et al. Intratracheal Dilation-injection Technique in the Treatment of Granulomatosis with Polyangiitis Patients with Subglottic Stenosis. J Rheumatol. 2016; 43(11): 2042-2048. doi:10.3899/jrheum.151355.
19. Shabani S, Hoffman MR, Brand WT, Dailey SH. Endoscopic Management of Idiopathic Subglottic Stenosis: Factors Affecting Inter-Dilation Interval. Ann Otol Rhinol Laryngol. 2017; 126(2): 96-102. doi:10.1177/0003489416675357.
20. Erlandsson A, Lundquist A, Olofsson K. Mapping quality of life after balloon dilatation in subglottic stenosis using Dyspnea index and Short Form Health Survey-36. Eur Arch Otorhinolaryngol. 2024; 281(7): 3701-3706. doi:10.1007/s00405-024-08667-0.
21. Wierzbicka M, Tokarski M, Puszczewicz M, Szyfter W. The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology. J Laryngol Otol. 2016; 130(7): 674-679. doi:10.1017/S0022215116001122.
22. Enver N, Ramaswamy A, Pitman MJ. How I Do It: A Novel Technique for Endoscopic Placement of Stent in Management of Anterior Glottic Webs. The Laryngoscope. 2021; 131(6): 1320-1323. doi:10.1002/lary.28965.
23. Gelbard A, Donovan DT, Ongkasuwan J, et al. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. The Laryngoscope. 2016; 126(6): 1390-1396. doi:10.1002/lary.25708.
24. Yılmaz T. Endoscopic Z-plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients. The Laryngoscope. 2021; 131(2). doi:10.1002/lary.28787.
25. Davis RJ, Lina I, Motz K, et al. Endoscopic Resection and Mucosal Reconstitution With Epidermal Grafting: A Pilot Study in Idiopathic Subglottic Stenosis. Otolaryngol--head neck surg. 2022; 166(5): 917-926. doi:10.1177/01945998211028163.
26. Damrose EJ, Beswick DM. Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap. Otolaryngol--head neck surg. 2016; 154(3): 568-571. doi:10.1177/0194599815622626.
27. Aarnæs MT, Sandvik L, Brøndbo K. Idiopathic subglottic stenosis: an epidemiological single-center study. Eur Arch Otorhinolaryngol. 2017; 274(5): 2225-2228. doi:10.1007/s00405-017-4512-0.
28. Kraft SM, Sykes K, Palmer A, Schindler J. Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis. Ann Otol Rhinol Laryngol. 2015; 124(2): 137-142. doi:10.1177/0003489414548915.
29. Gallagher L, Todatry S, Oldenburg K, Misono S, Gray R. Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway. The Laryngoscope. 2024; 134(6): 2672-2677. doi:10.1002/lary.31229.
30. Shoffel-Havakuk H, Lahav Y, Shopen Y, Reuven Y, Bachar G, Hamzany Y. Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis. The Laryngoscope. 2023; 133(4): 883-889. doi:10.1002/lary.30293.
31. Feinstein AJ, Goel A, Raghavan G, et al. Endoscopic Management of Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg. 2017; 143(5): 500-505. doi:10.1001/jamaoto.2016.4131.
32. Rosen CA, Wang H, Cates DJ, Smith LJ. The glottis is not round: Teardrop-shaped glottic dilation for early posterior glottic stenosis. The Laryngoscope. 2019; 129(6): 1428-1432. doi:10.1002/lary.27594.
33. McCaffrey TV. Classification of laryngotracheal stenosis. Laryngoscope. 1992; 102(12 Pt 1): 1335-1340. doi:10.1288/00005537-199212000-00004.
2. Laryngeal Stenosis: Practice Essentials, Problem, Epidemiology. Published online November 28, 2023. Accessed June 4, 2024. https://emedicine.medscape.com/article/867177-overview#a1?form=fpf.
3. Anh TH, Anh TT, Duy PQ, Dung NTN. Khảo sát các phương pháp điều trị sẹo hẹp thanh - khí quản tại Bệnh viện Tai mũi họng TP Hồ Chí Minh. VMJ. 2023; 529(1). doi:10.51298/vmj.v529i1.6298.
4. Yamamoto K, Kojima F, Tomiyama K ichi, Nakamura T, Hayashino Y. Meta-Analysis of Therapeutic Procedures for Acquired Subglottic Stenosis in Adults. The Annals of Thoracic Surgery. 2011; 91(6): 1747-1753. doi:10.1016/j.athoracsur.2011.02.071.
5. Suzuki H, Tanifuji T, Hasegawa I, Fukunaga T. A forensic autopsy case of death from laryngeal stenosis due to a late complication of radiotherapy. Legal Medicine. 2016; 20: 15-17. doi:10.1016/j.legalmed.2016.03.004.
6. Nair S, Nilakantan A, Sood A, Gupta A, Gupta A. Challenges in the Management of Laryngeal Stenosis. Indian J Otolaryngol Head Neck Surg. 2016; 68(3): 294-299. doi:10.1007/s12070-015-0936-2.
7. Pan DR, Rosow DE. Office-based corticosteroid injections as adjuvant therapy for subglottic stenosis. Laryngoscope Investig Oto. 2019; 4(4): 414-419. doi:10.1002/lio2.284.
8. Lucioni M, Bertolin A, Lionello M, et al. Transoral laser microsurgery for managing laryngeal stenosis after reconstructive partial laryngectomies. The Laryngoscope. 2017; 127(2): 359-365. doi:10.1002/lary.26056.
9. Hseu AF, Benninger MS, Haffey TM, Lorenz R. Subglottic stenosis: A ten-year review of treatment outcomes. The Laryngoscope. 2014; 124(3): 736-741. doi:10.1002/lary.24410.
10. Zhao J, Li J, Guo H. A Novel Keel for Treatment of Anterior Glottic Webs. American Journal of Otolaryngology and Head and Neck Surgery. 2019; 2(9). Accessed June 28, 2025. https://www.remedypublications.com/american-journal-of-otolaryngology-and-head-and-neck-surgery-abstract.php?aid=5249.
11. Neevel AJ, Schuman AD, Morrison RJ, Hogikyan ND, Kupfer RA. Serial Intralesional Steroid Injection for Subglottic Stenosis: Systemic Side Effects and Impact on Surgery-Free Interval. OTO Open. 2021; 5(4): 2473974X211054842. doi:10.1177/2473974X211054842.
12. Jiam NT, Dwyer CD, Rosen CA. Awake Laser Laryngeal Stenosis Surgery. The Laryngoscope. 2021; 131(5): E1633-E1637. doi:10.1002/lary.29295.
13. Maldonado F, Loiselle A, DePew ZS, et al. Idiopathic subglottic stenosis: An evolving therapeutic algorithm: Idiopathic Subglottic Stenosis. The Laryngoscope. 2014; 124(2): 498-503. doi:10.1002/lary.24287.
14. Wehbi N, Gleadhill CME, Ahmadian D, Skirko JR, Yip HT. In-office serial intralesional steroid injection for subglottic stenosis: Case series of 14 patients with multiple etiologies. World J Otorhinolaryngol Head Neck Surg. 2024; 11(1): 17-22. doi:10.1002/wjo2.159.
15. Hoffman MR, Coughlin AR, Dailey SH. Serial office-based steroid injections for treatment of idiopathic subglottic stenosis. The Laryngoscope. 2017; 127(11): 2475-2481. doi:10.1002/lary.26682.
16. Franco RA, Husain I, Reder L, Paddle P. Awake serial intralesional steroid injections without surgery as a novel targeted treatment for idiopathic subglottic stenosis. The Laryngoscope. 2018; 128(3): 610-617. doi:10.1002/lary.26874.
17. Hoffman MR, Francis DO, Mai JP, Dailey SH. Office-Based Steroid Injections for Idiopathic Subglottic Stenosis: Patient-Reported Outcomes, Effect on Stenosis, and Side Effects. Ann Otol Rhinol Laryngol. 2020; 129(4): 361-368. doi:10.1177/0003489419889066.
18. Fijolek J, Wiatr E, Gawryluk D, et al. Intratracheal Dilation-injection Technique in the Treatment of Granulomatosis with Polyangiitis Patients with Subglottic Stenosis. J Rheumatol. 2016; 43(11): 2042-2048. doi:10.3899/jrheum.151355.
19. Shabani S, Hoffman MR, Brand WT, Dailey SH. Endoscopic Management of Idiopathic Subglottic Stenosis: Factors Affecting Inter-Dilation Interval. Ann Otol Rhinol Laryngol. 2017; 126(2): 96-102. doi:10.1177/0003489416675357.
20. Erlandsson A, Lundquist A, Olofsson K. Mapping quality of life after balloon dilatation in subglottic stenosis using Dyspnea index and Short Form Health Survey-36. Eur Arch Otorhinolaryngol. 2024; 281(7): 3701-3706. doi:10.1007/s00405-024-08667-0.
21. Wierzbicka M, Tokarski M, Puszczewicz M, Szyfter W. The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology. J Laryngol Otol. 2016; 130(7): 674-679. doi:10.1017/S0022215116001122.
22. Enver N, Ramaswamy A, Pitman MJ. How I Do It: A Novel Technique for Endoscopic Placement of Stent in Management of Anterior Glottic Webs. The Laryngoscope. 2021; 131(6): 1320-1323. doi:10.1002/lary.28965.
23. Gelbard A, Donovan DT, Ongkasuwan J, et al. Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis. The Laryngoscope. 2016; 126(6): 1390-1396. doi:10.1002/lary.25708.
24. Yılmaz T. Endoscopic Z-plasty for Treatment of Supraglottic Stenosis: Experience on Nine Patients. The Laryngoscope. 2021; 131(2). doi:10.1002/lary.28787.
25. Davis RJ, Lina I, Motz K, et al. Endoscopic Resection and Mucosal Reconstitution With Epidermal Grafting: A Pilot Study in Idiopathic Subglottic Stenosis. Otolaryngol--head neck surg. 2022; 166(5): 917-926. doi:10.1177/01945998211028163.
26. Damrose EJ, Beswick DM. Repair of Posterior Glottic Stenosis with the Modified Endoscopic Postcricoid Advancement Flap. Otolaryngol--head neck surg. 2016; 154(3): 568-571. doi:10.1177/0194599815622626.
27. Aarnæs MT, Sandvik L, Brøndbo K. Idiopathic subglottic stenosis: an epidemiological single-center study. Eur Arch Otorhinolaryngol. 2017; 274(5): 2225-2228. doi:10.1007/s00405-017-4512-0.
28. Kraft SM, Sykes K, Palmer A, Schindler J. Using Pulmonary Function Data to Assess Outcomes in the Endoscopic Management of Subglottic Stenosis. Ann Otol Rhinol Laryngol. 2015; 124(2): 137-142. doi:10.1177/0003489414548915.
29. Gallagher L, Todatry S, Oldenburg K, Misono S, Gray R. Endoscopic treatment of subglottic stenosis with flexible bronchoscopy via laryngeal mask airway. The Laryngoscope. 2024; 134(6): 2672-2677. doi:10.1002/lary.31229.
30. Shoffel-Havakuk H, Lahav Y, Shopen Y, Reuven Y, Bachar G, Hamzany Y. Dilation, Steroid Injection, and Cough Exercise for Correction of Posterior Glottic Stenosis. The Laryngoscope. 2023; 133(4): 883-889. doi:10.1002/lary.30293.
31. Feinstein AJ, Goel A, Raghavan G, et al. Endoscopic Management of Subglottic Stenosis. JAMA Otolaryngol Head Neck Surg. 2017; 143(5): 500-505. doi:10.1001/jamaoto.2016.4131.
32. Rosen CA, Wang H, Cates DJ, Smith LJ. The glottis is not round: Teardrop-shaped glottic dilation for early posterior glottic stenosis. The Laryngoscope. 2019; 129(6): 1428-1432. doi:10.1002/lary.27594.
33. McCaffrey TV. Classification of laryngotracheal stenosis. Laryngoscope. 1992; 102(12 Pt 1): 1335-1340. doi:10.1288/00005537-199212000-00004.