重度先天性喉软化的外科治疗（附16例报道）

吕颜露; 黄琦; 吕静荣; 吴皓

doi:10.13201/j.issn.1001-1781.2013.09.017

重度先天性喉软化的外科治疗（附16例报道）

- 上海交通大学医学院附属新华医院耳鼻咽喉-头颈外科上海交通大学医学院耳科学研究所(上海, 200092)

详细信息

通讯作者: 黄琦,E-mail:huangqi3300@hotmail.com

中图分类号: R767

收稿日期: 2013-02-16

Surgical management for severe congenital laryngomalacia:16 consecutive cases

- Department of Otorhinolaryngology-Head and Neck Surgery, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Jiao Tong University Ear Institute, Shanghai, 200092, China

More Information

Corresponding author: HUANG Qi, E-mail: huangqi3300@hotmail.com

Received Date: 16 February 2013

摘要

摘要: 目的:探讨重度先天性喉软化的诊治方法和疗效。方法:回顾性分析16例重度先天性喉软化患儿的临床表现、诊断、手术方法及术后随访资料。根据临床表现及电子喉镜检查确诊,并依据喉软化分型采取相应的声门上成形术。结果:16例患儿平均手术年龄为23周。14例行声门上成形术,2例伴气管软化者行气管切开术。声门上成形术后48 h喉喘鸣消失9例,呼吸困难解除6例,喂养困难消失7例。术后6个月随访,1例患儿因重症肺炎死亡,其余13例中喉喘鸣消失12例,改善1例;呼吸困难解除8例;喂养困难消失12例,改善1例。结论:声门上成形术能有效缓解重度喉软化所致的喉喘鸣、呼吸及喂养困难等症状,可作为重度先天性喉软化的首选外科治疗方式。
- 喉软化,先天性 /
- 治疗 /
- 声门上成形术 /
- 喉喘鸣
Abstract: Objective: Laryngomalacia is the most common cause for stridor in neonate and infant. Our study aims at assessing the outcome of surgical management in patients diagnosed by fibrolaryngoscope as congenital laryngomalacia.Method: Retrospective study of 16 patients undergoing surgery for severe laryngomalacia. The patients' symptoms, associated medical conditions and surgical management were recorded.Result: Stridor and feeding difficulty were observed in 16 patients on admission, while dyspnea was found in 11 patients. Medical co-morbidities exist in 14 cases.The mean age of surgery was 23 weeks,15 patients had follow-up records for 24 months. Fourteen cases underwent supraglottoplasty. Tracheotomy was performed on the other 2 cases complicated with tracheomalacia. Nine cases showed full recovery of stridor 48 hours post-supraglottoplasty, and 7 were free of feeding difficulties. In the 6 months' follow-up, complete or partial relief was achieved in all main symptoms and signs.Conclusion: Supraglottoplasty is effective in relieving stridor and feeding difficulty as well as respiratory insufficiency, which makes it a first line option for managing severe laryngomalacia.
- laryngomalacia,congenital /
- surgical management /
- supraglottoplasty /
- stridor

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参考文献(13)

[1]	RICHTER G T, THOMPSON D M. The surgical management of laryngomalacia[J]. Otolaryngol Clin North Am,2008, 41:837-864.
[2]	DAELMANS B, DEWEY K, ARIMOND M. New and updated indicators for assessing infant and young child feeding[J]. Food Nutrition bulletin, 2009, 30(2 Suppl):S256-262.
[3]	HOMPSON D M. Laryngomalacia: factors that influence disease severity and outcomes of management[J]. Curr Opinion Otolaryngol Head Neck Surg,2010, 18:564-570.
[4]	张娜, 徐文.儿童喉软化症[J]. 中国耳鼻咽喉头颈外科,2010, 7(3):166-168.
[5]	张天宇.小儿喉软化症的诊断与治疗[J]. 中国医学文摘耳鼻咽喉科学,2009,24(3):120-122.
[6]	WHYMARK A D, CLEMENT W A, KUBBA H, et al. Laser epiglottopexy for laryngomalacia: 10 years' experience in the west of Scotland[J]. Arch Otolaryngol Head Neck Surg,2006, 132:978-982.
[7]	LEE K S, CHEN B N, YANG C C,et al. CO₂ laser supraglottoplasty for severe laryngomalacia: a study of symptomatic improvement[J]. Int J Pediatric Otorhinolaryngol,2007, 71:889-895.
[8]	DICKSON J M, RICHTER G T, MEINZEN-DERR J,et al. Secondary airway lesions in infants with laryngomalacia[J]. Ann Otol Rhinol Laryngol,2009,118:37-43.
[9]	SCHROEDER J W Jr,BHANDARKAR N D,HOLINGER L D.Synchronous airway lesions and outcomes in infants with severe laryngomalacia requiring supraglottoplasty[J]. Arch Otolaryngol Head Neck Surg,2009,135:647-651.
[10]	GROBLEWSKI J C, SHAH R K, ZALZAL G H. Microdebrider-assisted supraglottoplasty for laryngomalacia[J]. Ann Otol Rhinol Laryngol,2009, 118:592-597.
[11]	O'DONNELL S, MURPHY J, BEW S, et al. Aryepiglottoplasty for laryngomalacia: results and recommendations following a case series of 84[J]. Int J Pediatr Otorhinolaryngol,2007, 71:1271-1275.
[12]	DENOYELLE F, MONDAIN M, GRESILLON N, et al. Failures and complications of supraglottoplasty in children[J]. Arch Otolaryngol Head Neck Surg,2003, 129:1077-1080.
[13]	REDDY D K, MATT B H. Unilateral vs bilateral supraglottoplasty for severe laryngomalacia in children[J]. Arch Otolaryngol Head Neck Surg, 2001, 127:694-699.