多手段联合手术策略在儿童难治性喉气道梗阻中的应用

程超; 钟建文; 仇书要; 杨李强; 刘大波

doi:10.13201/j.issn.2096-7993.2022.08.005

多手段联合手术策略在儿童难治性喉气道梗阻中的应用

- 南方医科大学深圳医院儿童耳鼻咽喉科(广东深圳，510000)

详细信息

通讯作者: 刘大波，E-mail：daboliu@163.com

中图分类号: R768.1

收稿日期: 2022-05-07

刊出日期: 2022-08-03

Application of multimodal combined surgical strategy in children with intractable laryngeal airway obstruction

- Department of Pediatric Otolaryngology, Shenzhen Hospital, Southern Medical University, Shenzhen, 510000, China

More Information

Corresponding author: LIU Dabo, E-mail: daboliu@163.com

Received Date: 07 May 2022

Publish Date: 03 August 2022

摘要

摘要: 目的探讨多手段联合治疗儿童难治性喉气道梗阻手术方法的选择和术中策略，为儿童难治性喉气道梗阻的诊治提供新的选择。方法回顾性分析2005年1月—2021年12月收治的12例儿童难治性喉气道梗阻患儿的临床资料。所有患儿均在硬质气管镜或支撑喉镜联合电子内镜下行微创手术治疗，手术方法包括喉显微器械、等离子消融术、球囊扩张术、药物支架植入、激光消融、高频圈套器圈套等。术后进行随访。结果所有患儿均在全身麻醉下完成手术，术中及术后无并发症发生。除1例双侧声带麻痹患儿因术后创面再次狭窄未能成功拔管外，其余均术后顺利拔管。其中9例良性占位性质的梗阻患儿随访5~60个月未见复发，2例恶性肿瘤(腺泡细胞癌和黏液表皮样癌)致梗阻的患儿分别随访24个月和36个月未见复发。结论内镜下多手术联合治疗对儿童难治性喉气道梗阻有效，与传统开胸手术比较具有创伤小、快捷、安全等优点。对于不同大小、位置及病理类型的梗阻应联合采用不同的手术方式及设备。
- 喉气管梗阻 /
- 微创手术 /
- 儿童 /
Abstract: Objective To explore the selection of surgical methods and intraoperative strategies for the treatment of children with intractable laryngeal airway obstruction, and to provide new options for the diagnosis and treatment of children with intractable laryngeal airway obstruction.Methods The clinical data of 12 children with intractable laryngeal airway obstruction treated by our team from January 2005 to December 2021 were retrospective analyzed. All the children were treated with minimally invasive surgery under rigid bronchoscope or suspension laryngoscope combined with electronic endoscope. The surgical methods included laryngeal microsurgery, plasma ablation, balloon dilatation, drug-eluting stents, laser ablation, endoscopic snare, etc. The patients were followed up after operation.Results All patients completed the operation under general anesthesia, and there were no intraoperative or postoperative complications. Except for one patient with bilateral vocal cord paralysis who failed to extubation due to restenosis, the others were successfully extubated after operation. Among them, 9 cases of benign space-occupying obstruction were followed up for 5-60 months without recurrence, and 2 cases of malignant tumor-induced obstruction were followed up for 24 months(acinar cell carcinoma) and 36 months(mucoepidermoid carcinoma) without recurrence.Conclusion Endoscopic multi-operation is effective for children with intractable obstruction. Compared with traditional thoracotomy, endoscopic multi-operation strategies has the advantages of less trauma, faster and safer. For different sizes, locations and pathological types of obstruction, different surgical equipment and methods should be combined.
- laryngotracheal obstruction /
- minimally invasive /
- children /
- surgery

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图 1 例1患儿临床资料 1a：术前气管镜内所见；1b：术中取出新生物；1c：术后病理示低级别黏液表皮样癌；图2 例2患儿术中情况 2a：分离后联合粘连部；2b：显微缝合受创黏膜；2c：部分切除杓状软骨；图3 手术前后对比 3a：术前喉镜检查；3b：术后1年随访。

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表 1 患儿诊断及手术术式分类

诊断	例数	麻醉方式	位置	介入方式	治疗方式
重度喉软化	7	静脉复合全身麻醉	声门上、会厌水平	支撑喉镜+内镜	等离子消融术+CPAP
声带麻痹	2	同上	声门	支撑喉镜+内镜	CO₂激光+等离子消融术+喉显微器械
声门下闭锁	1	同上	声门下	支撑喉镜+内镜	等离子消融术+球囊扩张+药物支架植入术
腺泡细胞癌	1	同上	主气管	硬质气管镜+内镜	高频圈套器圈套术+激光烧融术
黏液表皮样癌	1	同上	左侧支气管	硬质气管镜+内镜	器械钳除+微波止血术

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表 2 两种介入方式的优缺点比较

类型	优点	缺点
支撑喉镜+硬质气管镜	①拥有足够的管腔空间能够允许手术器械触及瘤体； ②拥有多个通道能够同时完成不同的操作； ③能连接呼吸机保证患儿氧供； ④在某些特殊病例中能够有效止血。	①必须全身麻醉； ②很难调节角度并无法到达较细的管腔； ③已经形成狭窄的部位无法通过。
软性气管镜	①能到达硬质镜无法到达的较细管腔； ②能通过已形成狭窄的部位； ③能在局部麻醉下进行操作。	①无法控制气道； ②大部分手术器械都无法通过。

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