儿童咽部等离子术后重度咽狭窄治疗的疗效观察  

Treatment of children's pharyngeal stenosis following pharyngeal surgery with coblation

作　　者：霍红[1] 李五一[1] 王剑[1] 杨大海[1] 刘建汉[1] 金晓峰[1] 牛燕燕[1] 

机构地区：[1]中国医学科学院北京协和医学院北京协和医院耳鼻咽喉科,北京100730

出　　处：《临床耳鼻咽喉头颈外科杂志》2017年第22期1716-1719,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨儿童咽部等离子手术后重度咽瘢痕狭窄的病因及治疗。方法:回顾性分析2012-06-2016-07期间住院治疗的5例等离子术后重度咽狭窄患儿(单纯鼻咽狭窄2例,鼻咽和口咽联合狭窄3例)的临床资料,5例患儿分别采用瘢痕切除、临近黏膜瓣或游离植皮修复创面、口咽狭窄横切纵缝、鼻咽部放置支架6个月以上等方式治疗。疗效评估:术前和术后的鼻塞和经鼻呼吸困难、张口呼吸、鼻涕多不易擤出、闭塞性鼻音、睡眠打鼾、睡眠多动不安、嗅觉减退、吞咽困难等主观症状评分变化,以及狭窄咽腔扩大情况。结果:5例患儿随访7~46个月,术后咽气道最大直径扩大到1.5~2.0cm,症状评分明显改善,无鼻咽反流及开放性鼻音。结论:联合不同手术扩大咽腔,创面争取黏膜化,同时放置鼻咽支撑物,是治疗儿童重度咽狭窄较理想的方法。Objective：Pharyngeal stenosis as a postoperative complication following pharyngeal surgery（tonsillectomy/adenoidectomy）with coblation is rare and may be difficult to treat.This report is to explore the causes of pharyngeal stenosis and presents our successful treatment experience.Method：From Jan 2012 to July 2016,5 children with pharyngeal stenosis（2 nasopharyngeal stenosis and 3 nasopharyngeal stenosis combined with oropharyngeal stenosis）secondary to pharyngeal surgery（tonsillectomy/adenoidectomy）in Peking Union Medical College Hospital were analyzed.Five cases with severe nasopharyngeal stenosis received surgery of scar resection,horizontal-to-vertical pharyngoplasty and local pharyngeal flap rotation;and three of them received free skin transplantation.After stenosis repair surgery,prolonged nasopharyngeal hollow stents were used for more than 6 months.To evaluate the therapeutic effect,pharyngeal cavities and symptoms of difficulty nasal breathing,mouth breathing,difficulty in blowing nose,hyponasal speech,snoring,restless sleep,anosmia,dysphagia were assessed and compared before and after surgery.Result：With 7-46 months follow-up,all symptoms of the 5 cases are ameliorated and the diameters of nasopharyx are more than 1.5 cm.No velopharyngeal insufficiency complication happened.Conclusion：Improper operation with coblation can cause severe pharyngeal stenosis.Flap rotation,horizontal-to-vertical pharyngoplasty and prolonged use nasopharyngeal hollow stents are reliable methods to correct pharyngeal stenosis following children＇s pharyngeal surgery.

关 键 词：扁桃体切除术 腺样体切除术 咽狭窄 术后并发症 再手术 低温等离子 

分 类 号：R766.9[医药卫生—耳鼻咽喉科]