喉气管重建术治疗儿童声门下狭窄的临床分析

摘要

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.%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.