改良声门上成形术治疗喉软化症的疗效评价

浦诗磊; 李晓艳

doi:10.13201/j.issn.1001-1781.2019.11.016

改良声门上成形术治疗喉软化症的疗效评价

浦诗磊,
李晓艳^,

- 上海交通大学附属上海市儿童医院耳鼻咽喉头颈外科(上海, 226001)
基金项目:
上海市科学技术委员会西医引导项目资助(No:16411960500)

详细信息

通讯作者: 李晓艳,E-mail:chhshent@163.com

中图分类号: R767.3

收稿日期: 2019-04-22

Therapeutic evaluation of modified supraglottoplasty for laryngomalacia

PU Shilei,
LI Xiaoyan^,

- Department of Otolaryngology Head and Neck Surgery, Shanghai Children's Hospital, Shanghai Jiaotong University, Shanghai, 226001, China

More Information

Corresponding author: LI Xiaoyan, E-mail: chhshent@163.com

Received Date: 22 April 2019

摘要

摘要: 目的:探讨改良声门上成形术治疗喉软化症的疗效评价。方法:22例行声门上成形术的喉软化症患儿,所有患儿全部行改良声门上成形术。Ⅰ型为消融披裂上多余的黏膜组织,内侧以麻醉插管为界,保留插管下方的部分披裂组织。Ⅱ型为消融短缩的杓会厌皱襞和(或)消融会厌外侧缘,使会厌与披裂分离,扩大喉入口。Ⅲ型为消融舌根及会厌谷的黏膜,不超过会厌舌面面积的1/2。所有患儿术后插管入ICU观察5 d。在术前、术后(拔管后)、术后1个月、术后半年对患儿喉软化症的严重程度评分。症状评分采用视觉模拟量表(VAS)由家长评分,包括喘鸣、反流或喂养困难、呛咳、呼吸困难、肺炎的频率或严重程度,临床评分由医师对患儿的喉梗阻、喉镜下声门上形态、吞咽功能、体重、睡眠呼吸监测评分。结果:22例喉软化症患儿术后均随访6个月,术前、术后、术后1个月、术后6个月评分差异有统计学意义(P<0.01)。患儿的喉喘鸣、呼吸困难、喂养困难等症状有不同程度的改善。结论:改良声门上成形术治疗儿童喉软化症简化了手术流程,疗效确切,安全可靠。本研究设计的评价体系更直观、客观地评价了喉软化症状的严重程度及手术效果,对病情评估及治疗流程有一定的参考价值。
- 喉软化症 /
- 声门上成形术 /
- 评价
Abstract: Objective: To evaluate the therapeutic effect of modified supraglottoplasty for laryngeal malacia in children. Method: All 22 children with laryngomalacia underwent modified supraglottoplasty were retrospectively analyzed. Surgical correction of type Ⅰ involved the ablation of redundant mucosal tissue over the arytenoids, keep the part below anesthetic intubation. Type Ⅱ was treated by ablation of the shortened aryepiglottic folds and/or ablation of the lateral edge of the epiglottis, separate the epiglottis with epiglottis to enlarge the laryngeal inlet. Type Ⅲ was corrected by ablating wound surfaces on the base of the tongue and epiglottic vallecula but no more than 1/2 area of lingual surface of epiglottis. All patients were kept intubated for 5 days after surgery in the intensive care unit(ICU). Evaluate the severity of laryngomalacia before and after surgery(extubation), 1 month after surgery, and 6 months after surgery. Visual analogue scale(VAS) was used to score the symptoms, including stridor, reflux or feeding difficulties, aspiration, dyspnea and frequency or severity of pneumonia. Clinical score was determined by the physician on the child's laryngeal obstruction, supraglottic morphology in laryngoscope, swallowing function, weight and the result of polysomnography. Result: All 22 children with laryngomalacia were followed up for 6 months after surgery, statistically significant differences in scores before, after, 1 month after and 6 months after surgery(P<0.01). The symptoms of stridor, dyspnea and feeding difficulties were improved in different degrees.Conclusion: Modified supraglottoplasty for children with laryngomalacia simplified the surgical procedure, and the therapeutic effect is safe and reliable. The evaluation system designed in this study is more intuitive and objective to evaluate the severity of laryngomalacia and the operative effect, which may has certain reference value for the evaluation of the condition and the treatment process.
- laryngomalacia /
- supraglottoplasty /
- evaluation

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