经纤维支气管镜介入治疗儿童获得性声门下狭窄  

Interventional treatment of acquired subglottic stenosis in children by fiberoptic bronchoscopy.

作　　者：段效军[1] 黄建宝[1] 王江平[1] 杨梅雨[1] 张喜[1] 陈艳萍[1] Duan Xiaojun;Huang Jianbao;Wang Jiangping;Yang Meiyu;Zhang Xi;Chen Yanping(Hunan Children's Hospital,Changsha 410007)

机构地区：[1]湖南省儿童医院,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2020年第7期631-635,共5页Journal of Clinical Pediatric Surgery

基　　金：湖南省科技厅临床医疗创新引导项目(编号:2018SK50406)。

摘　　要：目的探讨儿童获得性声门下狭窄经纤维支气管镜的介入治疗方法及其有效性。方法回顾性分析2019年1月至2019年11月湖南省儿童医院收治的12例获得性声门下狭窄患儿临床资料;男9例,女3例;年龄26天至3岁11个月。参考Freitag的中心气道狭窄分类标准对入组患儿声门下狭窄进行形态学分类,根据患儿的Freitag形态学分类特点选择纤维支气管镜介入治疗方法。结果12例中11例达到临床治愈,有效率达91.67%,其中7例长度<1 cm的声门下短段瘢痕性狭窄患儿单用球囊扩张即可达到治疗效果,2例声门下狭窄段长度超过1 cm的患儿和2例气管内肉芽组织增生患儿需要多种介入方法联合治疗。1例合并先天性心脏病和猫叫综合征的患儿介入治疗无效,不能撤离呼吸机。结论经纤维支气管镜介入治疗儿童获得性声门下狭窄有效。Freitag的中心气道狭窄分类标准可用于指导医生选择儿童获得性声门下狭窄的介入治疗方法和评估预后。对于声门下短段瘢痕性狭窄(<1 cm)患儿,推荐单用球囊扩张治疗,以减少手术时间,并缩短疗程。Objective To explore the interventional therapy and effectiveness of fiberoptic bronchoscopy for children with acquired subglottic stenosis.Methods From January 2019 to November 2019,retrospective analysis was performed for clinical data of 12 hospitalized children with acquired subglottic stenosis.There were 9 boys and 3 girls with a median age of 10.8 months(26 days to 47 months).According to the Freitag s classification standard of central airway stenosis,the morphological classification of subglottic stenosis was implemented.Different interventions were selected based upon the characteristics of Freitag s morphological classification.Results Eleven cases were cured clinically with an effective rate of 91.67%.And 7 cases with a length of<1cm underwent balloon dilation alone.Two children with subglottic stenosis>1 cm in length and two cases of endotracheal granulomatosis received multiple interventions.One child with congenital heart disease and Cri-du-chat syndrome had no response to interventional therapy and could not be weaned off from a ventilator.Conclusion Interventional treatment is both safe and effective for acquired subglottic stenosis in children.Freitag s criteria for classifying central airway stenosis may be employed to guide the choice of interventional therapy and evaluate the prognosis of children with acquired subglottic stenosis.For short scarred subglottic stenosis(<1 cm),balloon dilation alone is recommended due to a shorter operative duration and simpler treatment sequence.

关 键 词：支气管镜检查 声门/外科学 声门/损伤 儿童 

分 类 号：R616.5[医药卫生—外科学]