支气管镜下氩气刀冷冻联合治疗儿童气管插管后严重气管狭窄一例及文献复习  

Argon plasma coagulation combined with cryotherapy via bronchoscopy for the treatment of one child with severe post-intubation tracheal stenosis and literature review

作　　者：周阔[1] 梁珺[1] 崔爱华[1] 付爱霞[1] 杨巧芝[1] 

机构地区：[1]山东省聊城市人民医院儿科,252000

出　　处：《中华儿科杂志》2013年第10期771-774,共4页Chinese Journal of Pediatrics

摘　　要：目的观察电子支气管镜下氩气刀冷冻联合治疗儿童气管插管后严重气管狭窄的近期效果。方法患儿男，3岁，因“头胸腹部复合外伤37d，呼吸困难28d，加重1d”入院。诊断为：气管狭窄，喉梗阻Ⅲ度，头胸腹部复合外伤手术后。采用全身麻醉，电子支气管镜经喉罩到达气管狭窄处，用氩气刀切割狭窄部，活检钳清理坏死组织，冷冻切割部黏膜。术后即刻、1d、10d、1个月、6个月观察患儿临床症状、体征及行电子支气管镜检查，了解近期疗效并复习相关文献。结果患儿经氩气刀联合冷冻治疗后即刻气管增生组织消失，喉鸣及呼吸困难表现明显减轻，发绀消失；手术10d后，患儿一般情况好，无喉鸣及呼吸困难表现；术后1、6个月，患儿行电子支气管镜复查示氩气刀切割部黏膜光滑，无气管狭窄。结论电子支气管镜下氩气刀冷冻联合治疗儿童气管插管后严重气管狭窄有很好效果，可进一步探索应用。Objective To observe the short term effect of argon plasma coagulation （APC） combined with cryotherapy via bronchoscopy for treatment of severe post-intubation tracheal stenosis in a child. Method A 3-year old boy was admitted for cephalothorax abdominal compound trauma and dyspnea, who had severe post-incubation tracheal stenosis. The agreement about the operation risk was signed by the parents. Endotracheal APC procedure was performed with a bronehoscope under general anesthesia. The APC probe was put into the working channel of the bronchoscope. The stenotie lesion was endoscopically visualized and then coagulated by argon plasma. Such coagulation was carried out several times at the stenotic site until it gradually became dilated. The devitalized tissue was mechanically removed with grasping forceps. Thereafter, bronehoseopic cryosurgery was repeatedly performed at the stenotic site. Clinical symptoms,signs and bronchoscopic manifestations were observed right after operation,after 1 day, 10 days, 1 month and 6 months separately. Result Tracheal tissue hyperplasia and cyanosis disappeared, laryngeal stridor and dyspnea improved obviously right after the operation. General condition of the patient was well, there was no laryngeal stridor and dyspnea 10 days after operation. The mueosa of the surgical site was smooth and no tracheostenosis was seen under bronchoscope at 1 month and 6 months after the operation. Conclusion Argon plasma coagulation combined with cryotherapy via bronchoscope is an effective method to treat tracheal stenosis of children,which needs further exploration for the application.

关 键 词：气管狭窄 冷冻疗法 支气管镜检查 儿童 氩等离子凝固术 

分 类 号：R726.5[医药卫生—儿科]