婴幼儿先天性声门下血管瘤的诊断和治疗  

Diagnosis and treatment of infantile congenital subglottic hemangioma

作　　者：程岚[1] 黄琦[1] 吴皓[1] 杨军[1] 陈立[1] 张治华[1] 

机构地区：[1]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200092

出　　处：《临床耳鼻咽喉头颈外科杂志》2009年第15期693-696,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨婴幼儿先天性声门下血管瘤的诊断和治疗。方法:9例患儿,反复喉喘鸣、喂哺困难及喉梗阻发作,电子支气管镜检查确诊为先天性声门下血管瘤。7例为声门下单侧病变,2例为双侧病变。其中8例采用气管切开后血管瘤内平阳霉素注射法进行治疗,术后患儿带金属气管套管出院,2周后门诊随访电子支气管镜复查,如果肿瘤未消失,再次行平阳霉素注射,直至肿瘤完全消失后进行堵管及拔管;1例单侧声门下血管瘤行瘤体吸割术,未行气管切开。结果:平阳霉素治疗的6例声门下单侧病变患者经过1次治疗后血管瘤完全消失,2例双侧病变患者经过2次治疗后血管瘤完全消失,8例均顺利堵管及拔管。1例行声门下血管瘤吸割术患者,术后2周复查黏膜光滑,完全修复。结论:对于体积较大,阻塞声门下腔范围较广的血管瘤,采用气管切开后血管瘤内平阳霉素注射法,能迅速解除气道梗阻,缩短自然病程,且戴管时间短,无术后声门下狭窄,是一种安全有效的治疗措施。对于体积较小的声门下血管瘤,在麻醉配合良好的情况下,行吸割术并给予良好止血,可避免气管切开,起到微创效果。Objective：To discuss the diagnosis and treatment of infantile congenital subglottic hemangioma. Method： Nine patients with recurrent stridor, feeding difficulties and laryngeal obstruction were diagnosed as congenital subglottic hemangioma with bronchia endoscopy. The lesions were unilateral in 7 cases and bilateral ira 2 cases. Eight cases were treated by intralesional Pingyangmycin injection after tracheotomy. Patients were discharged with metal trachea and were followed up endoscopicaliy 2 weeks thereafter. A second treatment would he required if the tumor reduced in size but not disappeared completely. Plugging tubes and extubation would be done when the tumor disappeared completely. One case with unilateral lesion underwent power-assisted tumor resection without traeheotomy. Result： Hemangioma vanished completely in 6 patients with unilateral subglottic hemangioma who were treated with single stage procedure. Tumor size was found reduced significantly after one procedure and vanished completely after a second procedure in 2 cases with bilateral subglottic hemangioma. All of the 8 cases were extubated successfully. The patient recovered thoroughly in two weeks after power-assisted tumor resection. Conclusion： Intralesional Pingyangmycin injection after tracheotomy can relief the airway obstruction quickly, shorten the nature course of hemangioma, shorten the period of wearing trachea, has no complication such as subglottic stenosis and is thought to be a safe and effective therapy for large size hemangioma. Power-assisted tumor resec tion under good total anesthesia without tracheotomy combined with well hemostasis is effective, less injure, and suitable for small size hemangioma.

关 键 词：声门下 血管瘤 平阳霉素 婴幼儿 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]