KẾT QUẢ ĐIỀU TRỊ SẸO HẸP THANH – KHÍ QUẢN TẠI BỆNH VIỆN ĐẠI HỌC Y DƯỢC TP. HỒ CHÍ MINH

Abstract

Background: Laryngotracheal stenosis (LTS) in adults is a complex condition with multiple etiologies, most commonly resulting from prolonged endotracheal intubation or tracheostomy. Other causes include laryngeal or tracheal surgery, head and neck trauma, and infection. In Vietnam, the incidence of LTS has been increasing due to the growing number of patients requiring prolonged mechanical ventilation in intensive care units. However, systematic reports on clinical characteristics and treatment outcomes remain limited. Objectives: To evaluate the clinical, endoscopic, and CT-scan characteristics of laryngotracheal stenosis and to describe treatment outcomes at the University Medical Center Ho Chi Minh City from 2019 to 2025. Methods: A retrospective study was conducted on patients diagnosed with LTS and treated at the University Medical Center Ho Chi Minh City between January 2019 and March 2025. Clinical assessment was performed through detailed medical history review and medical record analysis. The characteristics of the stenotic lesions were identified by laryngotracheal endoscopy and computed tomography (CT) scans, and compared with intraoperative findings. Postoperative outcomes were evaluated clinically based on airway patency and voice quality during the 3-month follow-up period. Results: A total of 47 patients were included in the study, comprising 12 cases of glottic stenosis (GS) and 35 cases of subglottic–tracheal stenosis (SGTS). The male-to-female ratio was nearly equal (51.1% vs. 48.9%). The most common cause was trauma following prolonged endotracheal intubation or tracheostomy (61.7%). Rigid fibrotic stenosis accounted for the majority of cases (61.7%). According to Cohen’s classification, GS was predominantly grade II (50%), while SGTS was mainly grade III (51.4%) based on the Myer–Cotton system. Normal bilateral vocal cord mobility was observed in 80.9% of patients. Endoscopic grading correlated completely with intraoperative findings in GS (100%) and in 88.6% of SGTS cases. CT-scan measurements (stenosis diameter and length) showed a strong correlation with intraoperative findings (r = 0.932 and r = 0.967, p < 0.01). Treatment methods included tracheal resection with end-to-end anastomosis, stent placement, and endoscopic interventions. The overall successful decannulation rate was 76.6%. Postoperative normal voice quality was preserved in 70.2% of patients, while 29.8% had varying degrees of dysphonia. Conclusions: Endoscopy and CT scanning are highly accurate diagnostic tools for assessing LTS characteristics and for preoperative planning. Treatment outcomes are determined not only by the restoration of airway patency but also by the preservation and recovery of vocal function.