中-重度婴幼儿喉软化症疗效比较分析

张炳煌; 骆献阳; 陈爱民; 姜元芹

doi:10.13201/j.issn.1001-1781.2018.18.010

中-重度婴幼儿喉软化症疗效比较分析

- 厦门大学附属第一医院耳鼻咽喉头颈外科(福建厦门, 361003)

详细信息

通讯作者: 骆献阳,E-mail:lxy701@126.com

中图分类号: R767

收稿日期: 2018-07-08

Analysis of infants with moderate to severe laryngomalacia

- Department of Otolaryngology Head and Neck Surgery, the First Affiliated Hospital of Xiamen University, Xiamen, 361003, China

More Information

Corresponding author: LUO Xianyang, E-mail: lxy701@126.com

Received Date: 08 July 2018

摘要

摘要: 目的：探讨中-重度婴幼儿喉软化症的临床特点，CO₂激光声门上成形术在喉软化症中的应用。方法：回顾性收集我院确诊的18例中-重度喉软化症婴幼儿的临床资料，其中10例中度患儿，8例重度患儿。按喉软化症分型，大部分为混合型，其中Ⅱ型2例、Ⅲ型3例、Ⅰ型+Ⅱ型5例、Ⅱ型+Ⅲ型7例、Ⅰ型+Ⅱ型+Ⅲ型1例。其中8例重度患儿接受CO₂激光声门上成形术，10例中度患儿行保守治疗。对8例手术患儿术后喉喘鸣、呼吸、体重、进食等进行评估，所有患儿跟踪随访12个月。结果：8例重度患儿行CO₂激光声门上成形术，术后喉喘鸣、呼吸困难、呛咳症状迅速得到改善，术后3个月均完全治愈。10例中度患儿3个月无一例治愈，6个月2例喉喘鸣、呼吸困难基本消失，7例症状好转，1例处于平台期；12个月8例患儿呼吸困难基本消失，2例轻度喉喘鸣，继续保守治疗。18例患儿均密切监测体重变化、饮食、呼吸情况，其中5例手术患儿在3、6、12个月体重比例均明显高于未手术患儿，差异有统计学意义（P<0.05）。结论：对可疑喉喘鸣患儿，使用电子喉镜有助于确诊中-重度喉软化症，患儿应该密切随访，严格把握手术适应证；对于重度喉软化症患儿建议积极手术治疗，CO₂激光声门上成形术对改善重度喉软化症患儿呼吸困难、喉喘鸣、进食困难及体重增长等具有重要作用，其手术创伤小、安全性高，并发症小，值得推广；对于中度喉软化症，建议密切随访，大部分可保守治疗，如有病情变化，可考虑手术治疗。
- 喉软化症 /
- 喉喘鸣 /
- 声门上成形术
Abstract: Objective: To investigate the clinical features and the treatment of moderate-severe laryngeallacia, and the application of CO₂ laser supraglotation in laryngeallacia.Method: Collecting the clinical data of 18 infants with moderate-to-severe laryngeallacia diagnosed in our hospital,10 cases were moderate. Eight cases were severe children; according to the classification of laryngeallacia, most of them were mixed type, including 2 cases of type Ⅱ, 3 cases of type Ⅲ, 5 cases of typeⅠ + type Ⅱ, 7 cases of typeⅡ+ type Ⅲ, and 1 case of typeⅠ+ typeⅡ + type Ⅲ. Among them, 8 patients underwent CO₂ laser supraglotation,10 patients underwent conservative treatment.The children underwent surgery to evaluate the improvement of laryngeal wheezing, respiration, body weight, and Diet situation. All children were followed up for 12 months.Result: Eight cases with severe laryngeallacia receving CO₂ laser supraglotation had rapid improvement after surgery, including laryngeal wheezing, dyspnea, and cough symptoms. They were completely cured 3 months after surgery; None of the 10 cases of moderate children were cured in 3 months, 2 cases of laryngeal wheezing and dyspnea basically disappeared in 6 months, 7 cases improved, 1 case was in the plateau stage; Despnea in 8 cases of children basically disappeared 12 months later and 2 cases with mild throat wheezing, continuing conservative treatment; The weight changes, diet and respiration were closely monitored in all 18 children. The weight of the 5 children after surgery in the 3, 6 and 12 months were significantly higher than that in the untreated children. The difference was statistically significant (P<0.05).Conclusion: Electronic laryngoscope should be taked when children are suspected of laryngeal asthma, which could help diagnose moderate-severe laryngeallacia. Follow-up should be done closely. CO₂ laser supraglottic surgery for severe laryngeallacia, can relieve dyspnea, throat wheezing, eating difficulties and gain weight. The surgical is safety with very slight trauma and less complications, which is worth promoting; for moderate laryngeal softening, close follow-up is recommended, most of which can be treated conservatively. If there is a change in the condition, surgery should be considered.
- laryngomalacia /
- throat /
- glottic surgery

HTML全文

参考文献(12)

[1]	KANAWAKU Y, FUNAYAMA M, SAKAI J, et al.Sudden infant death:lingual thyroglossal duct cyst versus environmental factors[J].Forensic Sci Int, 2006, 27, 156:158-60.
[2]	OLNEY D R, GREINWALD J H Jr, SMITH R J, et al.Laryngomalacia and its treatment[J].Laryngoscope, 1999, 109:1770-1775.
[3]	THOMPSON D M.Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia:a newtheory of etiology[J].Laryngoscope, 2007, 117:1-33.
[4]	MUNSON P D, SAAD A G, EL-JAMAL S M, et al.Submucosal nerve hypertrophy in congenltal laryngomalacia[J].Laryngoscope, 2011, 121:627-629.
[5]	LIMA T M, GONÇALVES D U, GONÇALVES L V, et al.Flexible nasolaryngoscopy accuracy in laryngomalacia diagnosis[J].Braz J Otorhinolaryngol, 2008, 74:29-32.
[6]	LANDRY A M, THOMPSON D M.Laryngomalacia:disease presentation, spectrum, and management[J].Int J Pediatr, 2012, 2012:753526.
[7]	CZECHOWICZ J A, CHANG K W.Catch-up grpwth in infants with laryngomalacia after supraglottoplasty[J].Int J Pediatr Otorhinolaryngol, 2015, 79:1333-1336.
[8]	梁穗新, 何少茹, 桂娟, 等.婴儿中重度喉软化症临床转归及中长期随访研究[J].中国小儿急救医学, 2017, 24(4):278-281.
[9]	李兰, 张德伦, 赵宇, 等.CO2激光声门上成形术治疗婴幼儿喉软化症临床研究[J].中华耳鼻咽喉头颈外科杂志, 2013, 48(6):475-480.
[10]	VALERA F C, TAMASHIRO E, DE ARAÚJO M M, et al.Evaluation of the efficacy of supraglottoplasty in obstructive sleep apnea syndrome associated with severe laryngomalacia[J].Arch Otolaryngol Head Neck Surg, 2006, 132:489-493.
[11]	张天宇.儿童气道软化的诊断与治疗[J].中国医学文摘(耳鼻咽喉科), 2013, 28(1):9-12.
[12]	THOMPSON D M.Laryngomalacia:factors that influence disease severity and outcomes of management[J].Curr Opin Otolaryngol Head Neck Surg, 2010, 18:564-570.