Objective: To explore the optimization and effect analysis of laryngotracheal stenosis surgery planning based on the Myer and Cotton grade, disease course, control of the primary disease, and the general condition of the body under the influence of various factors. Methods: A retrospective analysis was performed for 32 patients with acquired laryngotracheal stenosis who received surgical treatment from October 2015 to December 2021. Results: Surgical procedures included sleeve resection and end to end anastomosis (n = 16), partial circumferential tracheal resection (n = 2), tracheal granulation (scar) resection using a CO ₂ laser (n = 2), and T-tube insertion (n = 12). Successful decannulation was achieved in 31 patients (96.9%). Post-operative complications comprised: Subcutaneous emphysema (n = 25), subcutaneous infection (n = 6), anastomotic restenosis (n = 4), and anterior cervical tracheal fistula (n = 4). Conclusion: Considering multiple factors, the optimization of the surgical plan according to the degree of stenosis, the disease course, control of the primary disease, and the patient’s general condition was an important guarantee to improve the curative effect of laryngotracheal stenosis.