中华耳鼻咽喉头颈外科杂志
中華耳鼻嚥喉頭頸外科雜誌
중화이비인후두경외과잡지
CHINESE JOURNAL OF OTORHINOLARYNGOLOGY HEAD AND NECK SURGERY
2012年
12期
978-981
,共4页
谭乐恬%陈琦%林岳鑫%张天宇
譚樂恬%陳琦%林嶽鑫%張天宇
담악념%진기%림악흠%장천우
喉狭窄%耳鼻喉外科手术%组织移植%儿童
喉狹窄%耳鼻喉外科手術%組織移植%兒童
후협착%이비후외과수술%조직이식%인동
Laryngostenosis%Otorhinolaryngologic surgical procedures%Tissue transplantation%Child
目的 通过对5例行喉气管重建术治疗的儿童声门下狭窄病例的临床分析,探讨该术式的适应证选择、术中与术后处理及其风险.方法 报道2008年9月至2010年2月收治的5例声门下狭窄患儿,女4例,男1例;年龄4～6岁;先天性狭窄2例,获得性狭窄3例;Cotton-Myer分级:轻Ⅲ度狭窄1例,重Ⅲ度3例,Ⅳ度1例.全部采用喉气管重建术,其中1例轻Ⅲ度狭窄患儿未行气管切开造口术,另外4例入院时已行气管切开造口术.结果 5例患儿术后肋软骨移植物成活与生长良好,术后喉气管镜见声门下管腔扩大,4例Ⅲ度狭窄改善至Ⅰ度狭窄,1例Ⅳ度狭窄改善至Ⅱ度狭窄,呼吸困难消失.4例术前有气管切开患儿半年内均成功拔管,其中1例声带前连合损伤引起声音嘶哑,2年后明显改善.所有患儿术后随访2年均未出现再狭窄.结论 喉气管重建术是治疗中-重度儿童声门下狭窄的有效方法,术前全面的检查评估与合适的手术方式选择是成功的关键.
目的 通過對5例行喉氣管重建術治療的兒童聲門下狹窄病例的臨床分析,探討該術式的適應證選擇、術中與術後處理及其風險.方法 報道2008年9月至2010年2月收治的5例聲門下狹窄患兒,女4例,男1例;年齡4～6歲;先天性狹窄2例,穫得性狹窄3例;Cotton-Myer分級:輕Ⅲ度狹窄1例,重Ⅲ度3例,Ⅳ度1例.全部採用喉氣管重建術,其中1例輕Ⅲ度狹窄患兒未行氣管切開造口術,另外4例入院時已行氣管切開造口術.結果 5例患兒術後肋軟骨移植物成活與生長良好,術後喉氣管鏡見聲門下管腔擴大,4例Ⅲ度狹窄改善至Ⅰ度狹窄,1例Ⅳ度狹窄改善至Ⅱ度狹窄,呼吸睏難消失.4例術前有氣管切開患兒半年內均成功拔管,其中1例聲帶前連閤損傷引起聲音嘶啞,2年後明顯改善.所有患兒術後隨訪2年均未齣現再狹窄.結論 喉氣管重建術是治療中-重度兒童聲門下狹窄的有效方法,術前全麵的檢查評估與閤適的手術方式選擇是成功的關鍵.
목적 통과대5례행후기관중건술치료적인동성문하협착병례적림상분석,탐토해술식적괄응증선택、술중여술후처리급기풍험.방법 보도2008년9월지2010년2월수치적5례성문하협착환인,녀4례,남1례;년령4～6세;선천성협착2례,획득성협착3례;Cotton-Myer분급:경Ⅲ도협착1례,중Ⅲ도3례,Ⅳ도1례.전부채용후기관중건술,기중1례경Ⅲ도협착환인미행기관절개조구술,령외4례입원시이행기관절개조구술.결과 5례환인술후륵연골이식물성활여생장량호,술후후기관경견성문하관강확대,4례Ⅲ도협착개선지Ⅰ도협착,1례Ⅳ도협착개선지Ⅱ도협착,호흡곤난소실.4례술전유기관절개환인반년내균성공발관,기중1례성대전련합손상인기성음시아,2년후명현개선.소유환인술후수방2년균미출현재협착.결론 후기관중건술시치료중-중도인동성문하협착적유효방법,술전전면적검사평고여합괄적수술방식선택시성공적관건.
Objective To study the effect of laryngotracheal reconstruction (LTR) in children with subglottic stenosis (SGS),and to discuss the indications and the risks of intraoperative and postoperative treatment of LTR.Methods From September 2008 to February 2010,5 children (4 girls and 1 boy,aged 4 to 6 years) were treated by LTR.Among the 5 children,there were 2 congenital SGS and 3 acquired SGS.One had mild grade Ⅲ SGS,3 had severe grade Ⅲ SGS,and one had grade Ⅳ SGS.One child with mild Ⅲ SGS was treated by single-stage LTR,and the rest four children were treated by double-stage LTR.The surgical technique consisted of cricoid lamina midline vertical incision,rib cartilage graft interposition and endotracheal tube (ETT) stenting for 2 to 3 weeks.Results Four children with grade Ⅲ SGS were decannulated 3 months after operation,and the child with grade V SGS got decannulated 6 months after operation.Of all children,rib cartilage graft growed well,and the size of subglottis were amplified by grade Ⅲ SGS to grade Ⅰ SGS,and grade Ⅳ SGS to grade Ⅱ SGS.All children obtained stable airway.One child with grade Ⅳ SGS who had hoarseness got effective phonation during follow-up 2 years after operation.Conclusions LTR is a safe and effective treatment for pediatric subglottic stenosis.The important factors of successful operation are correct assessment and evaluation of the severity and overall medical status and selection of suitable surgical techniques.
