CAJ | 학술논문

目的探讨CO2激光声门上成形术治疗重度婴幼儿喉软化症的临床效果及安全性.方法 2009年1月至2011年12月在深圳市儿童医院收治出生31～ 263 d的重度喉软化症患儿32例,依据治疗方案的不同,分为行CO2激光声门上成形术的手术组与保守治疗的对照组,每组16例,观察两组患儿症状改善及预后情况.结果 16例手术后患儿声门上塌陷得到有效纠正,术后患儿喉鸣、呼吸困难、呛咳症状迅速改善,呼吸道感染次数明显少于保守治疗的对照组.手术组患儿术后3个月时均治愈,治愈率100.0％；对照组治疗3个月时无治愈患儿,至6个月时仅1例患儿治愈,治愈率6.2％.治疗1个月、3个月、6个月时治愈率,手术组显著高于对照组,x2值分别为13.9、28.1、24.6,P值均＜0.01.治疗1个月、3个月、6个月,手术组患儿年龄别体重Z值中位数:-1.89、-0.96、-0.63；对照组-2.12、-2.17、-1.79,差异有统计学意义(z值分别为-0.848、-2.940、-4.110；P值均＜0.05或＜0.01).手术组患儿术前最低动脉血氧饱和度0.686±0.106((x)±s,下同),术后1个月0.901 ±0.041,术后显著提高,差异有统计学意义(t=-7.876,P=0.001).手术组并发症有会厌舌根粘连1例,新发短时呛咳1例,无其他严重并发症.结论 CO2激光声门上成形术治疗重度喉软化症能有效改善患儿喉鸣、呼吸困难和呛咳症状,减少患儿呼吸道感染,改善患儿生长发育,其治愈率较高,并发症较少,安全性较高.
목적 탐토CO2격광성문상성형술치료중도영유인후연화증적림상효과급안전성.방법 2009년1월지2011년12월재심수시인동의원수치출생31～ 263 d적중도후연화증환인32례,의거치료방안적불동,분위행CO2격광성문상성형술적수술조여보수치료적대조조,매조16례,관찰량조환인증상개선급예후정황.결과 16례수술후환인성문상탑함득도유효규정,술후환인후명、호흡곤난、창해증상신속개선,호흡도감염차수명현소우보수치료적대조조.수술조환인술후3개월시균치유,치유솔100.0％；대조조치료3개월시무치유환인,지6개월시부1례환인치유,치유솔6.2％.치료1개월、3개월、6개월시치유솔,수술조현저고우대조조,x2치분별위13.9、28.1、24.6,P치균＜0.01.치료1개월、3개월、6개월,수술조환인년령별체중Z치중위수:-1.89、-0.96、-0.63；대조조-2.12、-2.17、-1.79,차이유통계학의의(z치분별위-0.848、-2.940、-4.110；P치균＜0.05혹＜0.01).수술조환인술전최저동맥혈양포화도0.686±0.106((x)±s,하동),술후1개월0.901 ±0.041,술후현저제고,차이유통계학의의(t=-7.876,P=0.001).수술조병발증유회염설근점련1례,신발단시창해1례,무기타엄중병발증.결론 CO2격광성문상성형술치료중도후연화증능유효개선환인후명、호흡곤난화창해증상,감소환인호흡도감염,개선환인생장발육,기치유솔교고,병발증교소,안전성교고.
Objective To evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants.Methods From January 2009 to December 2011,32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital.According to the choice made by the parents,16 children accepted CO2 laser supraglottoplasty (group 1),the others were treated conservatively (group 2).The beginning observation point TO was defined as the age on the first medicine taking day or the age of surgery.T1,T3,T6 were defined as 1,3,6 months following TO.Clinical symptoms included stridor,dyspnea,aspiration,and respiratory infections.The body weight,PSG reports,laryngoscope findings,cure rates of the two groups were compared.Results The anatomical abnormalities were corrected surgically,and the symptoms,such as stridor,dyspnea,and aspiration improved rapidly after the operation.The cure rates was higher in group 1 than in group 2 on T1,T3,T6 stage.There were statistically significant differences(x2 were 13.9,28.1,24.6 respectively; all P ＜ 0.01).Children in group 1 gained weight better than in group 2.There was a statistically significant difference in Z scores median on T1,T3,T6 stage (z score were-0.848,-2.940,-4.110 ; P ＜ 0.05,or P ＜ 0.01 respectively).The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ±0.106 to 0.901 ±0.041).There was a statistically significant difference (t =-7.876,P =0.001).Complications included adhesion (1 case) and temporary new-onset aspiration (1 case).Conclusions The CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor,dyspnea and aspiration.It can reduce the frequency of respiratory infections,and contribute to weight gaining.The CO2 laser supraglottoplasty is effective,of high security and with rare complications.