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摘要: 先天性喉软化症是引起婴幼儿喉喘鸣最常见的原因，其发病机制尚无明确结论，可能与喉部软骨解剖结构发育异常、神经肌肉功能紊乱、胃食管及咽喉反流疾病等有关。典型表现为吸气性喉喘鸣、喂养困难，根据症状严重程度可分为轻、中、重度。主要结合临床症状、体征和内镜检查进行诊断，其中内镜检查是重要的诊断依据。喉软化症的治疗取决于症状的严重程度，轻度及部分中度患儿可经保守治疗自行缓解，部分中度及重度患儿应行手术治疗，声门上成形术是主要的手术方式，可有效地改善绝大多数先天性喉软化患儿喉喘鸣、吸气性呼吸困难、喂养困难、发育迟缓等症状，手术效果良好。Abstract: Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants. The pathogenesis has not yet been clearly concluded. It may be related to abnormal development of laryngeal cartilage anatomical structure, neuromuscular dysfunction, gastroesophageal and laryngeal reflux disease, etc. The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties, which can be divided into mild, moderate and severe according to the severity of symptoms. The diagnosis is mainly based on clinical symptoms, signs and endoscopy, among which endoscopy is an important diagnostic basis. The treatment of laryngomalacia depends on the severity of symptoms. Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment, and severe and some moderate congenital laryngomalacia children should be treated by surgery. Supraglottic plasty is the main surgical method, which can effectively improve the symptoms of laryngeal stridor, dyspnea, feeding difficulties and growth retardation in most children, and the surgical effect is good.
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Key words:
- laryngomalacia /
- electronic nasopharyngoscope /
- supraglottic plasty /
- treatment
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[1] Bedwell J, Zalzal G. Laryngomalacia[J]. Semin Pediatr Surg, 2016, 25(3): 119-122. doi: 10.1053/j.sempedsurg.2016.02.004
[2] Leonard JA, Reilly BK. Laryngomalacia in the Premature Neonate[J]. Neoreviews, 2021, 22(10): e653-e659. doi: 10.1542/neo.22-10-e653
[3] Jefferson ND, Cohen AP, Rutter MJ. Subglottic stenosis[J]. Semin Pediatr Surg, 2016, 25(3): 138-143. doi: 10.1053/j.sempedsurg.2016.02.006
[4] Escher A, Probst R, Gysin C. Management of laryngomalacia in children with congenital syndrome: the role of supraglottoplasty[J]. J Pediatr Surg, 2015, 50(4): 519-523. doi: 10.1016/j.jpedsurg.2014.05.035
[5] Yeung JC, Balakrishnan K, Cheng A, et al. International Pediatric Otolaryngology Group: Consensus guidelines on the diagnosis and management of type Ⅰ laryngeal clefts[J]. Int J Pediatr Otorhinolaryngol, 2017, 101: 51-56. doi: 10.1016/j.ijporl.2017.07.016
[6] Jain D, Jain S. Management of Stridor in Severe Laryngomalacia: A Review Article[J]. Cureus, 2022, 14(9): e29585.
[7] Hartl TT, Chadha NK. A systematic review of laryngomalacia and acid reflux[J]. Otolaryngol Head Neck Surg, 2012, 147(4): 619-626. doi: 10.1177/0194599812452833
[8] Simons JP, Greenberg LL, Mehta DK, et al. Laryngomalacia and swallowing function in children[J]. Laryngoscope, 2016, 126(2): 478-484. doi: 10.1002/lary.25440
[9] Mesallam TA. Oropharyngeal 24-Hour pH Monitoring in Children With Airway-Related Problems[J]. Clin Exp Otorhinolaryngol, 2016, 9(2): 168-172. doi: 10.21053/ceo.2015.00409
[10] Garritano FG, Carr MM. Characteristics of patients undergoing supraglottoplasty for laryngomalacia[J]. Int J Pediatr Otorhinolaryngol, 2014, 78(7): 1095-1100. doi: 10.1016/j.ijporl.2014.04.015
[11] Landry AM, Thompson DM. Laryngomalacia: disease presentation, spectrum, and management[J]. Int J Pediatr, 2012, 2012: 753526.
[12] Carter J, Rahbar R, Brigger M, et al. International Pediatric ORL Group(IPOG)laryngomalacia consensus recommendations[J]. Int J Pediatr Otorhinolaryngol, 2016, 86: 256-261. doi: 10.1016/j.ijporl.2016.04.007
[13] Lima TM, Gonçalves DU, Gonçalves LV, et al. Flexible nasolaryngoscopy accuracy in laryngomalacia diagnosis[J]. Braz J Otorhinolaryngol, 2008, 74(1): 29-32. doi: 10.1016/S1808-8694(15)30747-3
[14] Hartzell LD, Richter GT, Glade RS, et al. Accuracy and safety of tracheoscopy for infants in a tertiary care clinic[J]. Arch Otolaryngol Head Neck Surg, 2010, 136(1): 66-69. doi: 10.1001/archoto.2009.204
[15] Bhatt J, Prager JD. Neonatal Stridor: Diagnosis and Management[J]. Clin Perinatol, 2018, 45(4): 817-831. doi: 10.1016/j.clp.2018.07.015
[16] Benjamin B, Inglis A. Minor congenital laryngeal clefts: diagnosis and classification[J]. Ann Otol Rhinol Laryngol, 1989, 98(6): 417-420. doi: 10.1177/000348948909800603
[17] 汪景, 徐梦柔, 金蕾, 等. 新生儿小下颌畸形伴喉软化的气道管理及治疗[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(8): 622-625, 631. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.08.004
[18] Friedman S, Sadot E, Gut G, et al. Laryngeal ultrasound for the diagnosis of laryngomalacia in infants[J]. Pediatr Pulmonol, 2018, 53(6): 772-777. doi: 10.1002/ppul.23964
[19] 陶礼华, 黄敏, 李赟, 等. 新生儿先天性喉喘鸣患儿病因分析及其治疗研究[J]. 中国优生与遗传杂志, 2018, 26(11): 88-90, 104. https://www.cnki.com.cn/Article/CJFDTOTAL-ZYYA201811035.htm
[20] Bozkurt HB, Çelik M. Investigation of the serum vitamin D level in infants followed up with the diagnosis of laryngomalacia: a case-control study[J]. Eur Arch Otorhinolaryngol, 2021, 278(3): 733-739. doi: 10.1007/s00405-020-06412-x
[21] Hassan MM, Emam AM, Mahmoud AM, et al. Congenital laryngomalacia: Is it an inflammatory disease? The role of Vitamin D[J]. Laryngoscope, 2020, 130(2): 448-453. doi: 10.1002/lary.27997
[22] 陈良嗣, 樊孟耘, 付勇, 等. 儿童喉软化症诊断与治疗临床实践指南[J]. 临床耳鼻咽喉头颈外科杂志, 2020, 34(11): 961-965. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2020.11.001
[23] 中国医师协会儿科医师分会儿童耳鼻咽喉专业委员会. 婴幼儿喉气道结构异常评估的专家共识[J]. 临床耳鼻咽喉头颈外科杂志, 2023, 37(6): 403-408. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2023.06.001
[24] Lee KS, Chen HL, Yang CC, et al. Surgical management of severe laryngomalacia[J]. Journal of the Otolaryngological Society of the Republic of China, 1997, 32(3): 235-240.
[25] Clark CM, Kugler K, Carr MM. Common causes of congenital stridor in infants[J]. JAAPA, 2018, 31(11): 36-40. doi: 10.1097/01.JAA.0000546480.64441.af
[26] Holinger LD, Konior RJ. Surgical management of severe laryngomalacia[J]. Laryngoscope, 2010, 99(2): 136-142.
[27] 刘燕. 小儿重度喉软化症临床特点及手术疗效影响因素分析[D]. 重庆: 重庆医科大学, 2020.
[28] 李颖, 姜岚, 徐艳霞, 等. 低温等离子下声门上成形术对新生儿喉软化的疗效及预后研究[J]. 中国耳鼻咽喉头颈外科, 2021, 28(6): 379-382.
[29] Thompson DM. Abnormal sensorimotor integrative function of the larynx in congenital laryngomalacia: a new theory of etiology[J]. Laryngoscope, 2007, 117(6 Pt 2 Suppl 114): 1-33.
[30] 李鹏, 黄沂传, 徐艳丽, 等. 喉咽鳞癌组织中CK4基因的表达及其临床意义[J]. 齐鲁医学杂志, 2013, 28(2): 127-128.
[31] Yang Y, Zhou J, Wu H. Significance of Cytokeratin-1 Single-Nucleotide Polymorphism and Protein Level in Susceptibility to Vocal Leukoplakia and Laryngeal Squamous Cell Carcinoma[J]. ORL J Otorhinolaryngol Relat Spec, 2019, 81(2-3): 121-129. doi: 10.1159/000497747
[32] Carmona FD, Ou J, Jiménez R, et al. Development of the cornea of true moles(Talpidae): morphogenesis and expression of PAX6 and cytokeratins[J]. J Anat, 2010, 217(5): 488-500. doi: 10.1111/j.1469-7580.2010.01299.x
[33] Di Dio D, Amrhein P, Koitschev A, et al. [Supraglottoplasty for pediatric laryngomalacia: Results from 71 cases][J]. HNO, 2016, 64(12): 905-908. doi: 10.1007/s00106-016-0277-9
[34] Walner DL, Neumann DB, Hamming KK, et al. Supraglottoplasty in Infants: A Staged Approach[J]. Ann Otol Rhinol Laryngol, 2015, 124(10): 803-807. doi: 10.1177/0003489415585869
[35] Pu S, Xu H, Li X. Supraglottoplasty in neonates and infants: A radiofrequency ablation approach[J]. Medicine(Baltimore), 2018, 97(7): e9850.
[36] Sandu K, Reinhard A, Lambercy K, et al. Temporary tracheal stenting using endovascular prosthesis in the management of severe refractory stenosis following slide tracheoplasty[J]. Eur Arch Otorhinolaryngol, 2018, 275(1): 275-280. doi: 10.1007/s00405-017-4792-4
[37] Cohen O, Picard E, Joseph L, et al. Supraglottoplasty for severe laryngomalacia. Can we predict success?[J]. Int J Pediatr Otorhinolaryngol, 2020, 138: 110333. doi: 10.1016/j.ijporl.2020.110333
[38] Reddy DK, Matt BH. Unilateral vs. bilateral supraglottoplasty for severe laryngomalacia in children[J]. Arch Otolaryngol Head Neck Surg, 2001, 127(6): 694-649. doi: 10.1001/archotol.127.6.694
[39] Reichel O, Keller J, Rasp G, et al. Efficacy of once-daily esomeprazole treatment in patients with laryngopharyngeal reflux evaluated by 24-hour pH monitoring[J]. Otolaryngol Head Neck Surg, 2007, 136(2): 205-210. doi: 10.1016/j.otohns.2006.10.011
[40] Bozkurt HB, Celik M. Investigation of the serum vitamin D level in infants followed up with the diagnosis of laryngomalacia: a case-control study[J]. Eur Arch Otorhinolaryngol, 2021, 278(3): 733-739.
[41] 仇书要, 刘大波, 钟建文, 等. 声门上成形术联合无创正压通气治疗喉软化症[J]. 临床耳鼻咽喉头颈外科杂志, 2022, 36(4): 275-277. https://lceh.whuhzzs.com/article/doi/10.13201/j.issn.2096-7993.2022.04.007
[42] Petersson RS, Wetjen NM, Thompson DM. Neurologic variant laryngomalacia associated with Chiari malformation and cervicomedullary compression: case reports[J]. Ann Otol Rhinol Laryngol, 2011, 120(2): 99-103.
[43] Hoff SR, Schroeder JW Jr, Rastatter JC, et al. Supraglottoplasty outcomes in relation to age and comorbid conditions[J]. Int J Pediatr Otorhinolaryngol, 2010, 74(3): 245-249.
[44] Day KE, Discolo CM, Meier JD, et al. Risk factors for supraglottoplasty failure[J]. Otolaryngol Head Neck Surg, 2012, 146(2): 298-301.
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