CAJ | 학술논문

目的观察电子支气管镜下氩气刀冷冻联合治疗儿童气管插管后严重气管狭窄的近期效果.方法患儿男,3岁,因“头胸腹部复合外伤37 d,呼吸困难28 d,加重1d”人院.诊断为:气管狭窄,喉梗阻Ⅲ度,头胸腹部复合外伤手术后.采用全身麻醉,电子支气管镜经喉罩到达气管狭窄处,用氩气刀切割狭窄部,活检钳清理坏死组织,冷冻切割部黏膜.术后即刻、1d、10 d、1个月、6个月观察患儿临床症状、体征及行电子支气管镜检查,了解近期疗效并复习相关文献.结果患儿经氩气刀联合冷冻治疗后即刻气管增生组织消失,喉鸣及呼吸困难表现明显减轻,发绀消失；手术10 d后,患儿一般情况好,无喉鸣及呼吸困难表现；术后1、6个月,患儿行电子支气管镜复查示氩气刀切割部黏膜光滑,无气管狭窄.结论电子支气管镜下氩气刀冷冻联合治疗儿童气管插管后严重气管狭窄有很好效果,可进一步探索应用.
목적 관찰전자지기관경하아기도냉동연합치료인동기관삽관후엄중기관협착적근기효과.방법 환인남,3세,인“두흉복부복합외상37 d,호흡곤난28 d,가중1d”인원.진단위:기관협착,후경조Ⅲ도,두흉복부복합외상수술후.채용전신마취,전자지기관경경후조도체기관협착처,용아기도절할협착부,활검겸청리배사조직,냉동절할부점막.술후즉각、1d、10 d、1개월、6개월관찰환인림상증상、체정급행전자지기관경검사,료해근기료효병복습상관문헌.결과 환인경아기도연합냉동치료후즉각기관증생조직소실,후명급호흡곤난표현명현감경,발감소실；수술10 d후,환인일반정황호,무후명급호흡곤난표현；술후1、6개월,환인행전자지기관경복사시아기도절할부점막광활,무기관협착.결론 전자지기관경하아기도냉동연합치료인동기관삽관후엄중기관협착유흔호효과,가진일보탐색응용.
Objective To observe the short term effect of argon plasma coagulation (APC) combined with cryotherapy via bronchoscopy for treatment of severe post-intubation tracheal stenosis in a child.Method A 3-year old boy was admitted for cephalothorax abdominal compound trauma and dyspnea,who had severe post-incubation tracheal stenosis.The agreement about the operation risk was signed by the parents.Endotracheal APC procedure was performed with a bronchoscope under general anesthesia.The APC probe was put into the working channel of the bronchoscope.The stenotic lesion was endoscopically visualized and then coagulated by argon plasma.Such coagulation was carried out several times at the stenotic site until it gradually became dilated.The devitalized tissue was mechanically removed with grasping forceps.Thereafter,bronchoscopic cryosurgery was repeatedly performed at the stenotic site.Clinical symptoms,signs and bronchoscopic manifestations werc observed right after operation,after 1 day,10 days,1 month and 6 months separately.Result Tracheal tissue hyperplasia and cyanosis disappeared,laryngeal stridor and dyspnea improved obviously right after the operation.General condition of the patient was well,there was no laryngeal stridor and dyspnea 10 days after operation.The mucosa of the surgical site was smooth and no tracheostenosis was seen under bronchoscope at 1 month and 6 months after the operation.Conclusion Argon plasma coagulation combined with cryotherapy via bronchoscope is an effective method to treat tracheal stenosis of children,which needs further exploration for the application.