游离舌骨重建环状软骨治疗获得性声门下狭窄的疗效评估  

Evaluation of free hyoid bone reconstruction of cricoid cartilage in the treatment of acquired subglottic stenosis

作　　者：刘晓君 陈佳瑞[1] 徐宏鸣[1] 李晓艳[1] LIU Xiaojun;CHEN Jiarui;X U Hongming;LI Xiaoyan(Department of Otolaryngology Head and Neck Surgery,Shanghai Children's Hospital of Shanghai Jiaotong University,Shanghai Children's Hospital,Shanghai,200062,China)

机构地区：[1]上海交通大学附属儿童医院,上海市儿童医院耳鼻咽喉头颈外科,上海200062

出　　处：《中国耳鼻咽喉头颈外科》2021年第1期10-13,共4页Chinese Archives of Otolaryngology-Head and Neck Surgery

基　　金：游离舌骨重建环状软骨治疗儿童喉气管狭窄的临床研究(SHDC12019X21)。

摘　　要：目的探讨儿童获得性声门下狭窄诊断及治疗方法。方法对2017年6月~2019年6月因获得性声门下狭窄行喉气管重建术治疗的15例中重度的病例资料进行分析,所有患儿均行喉气管重建术。症状功能评分采用视觉模拟量表(VAS)由监护人评分,包括吞咽功能、肺炎的频率及严重性、语音质量,评估其治疗效果。结果评估声门下狭窄按Cotton分型:II型5例,III型6例,IV型4例。根据患儿年龄体重分析,置入7号T管12例,8号T管3例。术后误咽者8例,2例出现颈部感染,6例T管口上方肉芽增生,成功拔管率为86.67%。患儿在拔管后的功能评分较术前、术后1个月、术后3个月均有改善(P<0.05)。结论环状软骨前裂开+游离舌骨植入+T管置入术是治疗儿童声门下狭窄有效方式。早期的诊断治疗,有助于患儿的气道发育、身心健康,以及减少家庭经济负担。OBJECTIVE To study the diagnosis and treatment of acquired subglottic stenosis in infants.METHODS Fifteen children with moderate to severe subglottic stenosis were admitted to the Department of Otolaryngology Head and Neck Surgery of Shanghai Children’s Hospital from June 2017 to June 2019,and their clinical characteristics and treatment methods were analyzed.All the children underwent laryngotracheal reconstruction.Symptom function scores were scored by guardians using a visual analogue scale(VAS),including swallowing function,frequency and severity of pneumonia,and speech quality,to assess its therapeutic effect.RESULTS The subglottic stenosis was evaluated according to Cotton classification:5 cases of type II,6 cases of type III,and 4 cases of type IV.According to the age and weight of the children,12 cases of No.7 T tube and 3 cases of No.8 T tube were inserted.There were 8 cases of choking while drinking water,2 cases of neck infection and 6 cases with granulomatous hyperplasia above the T-tube.The rate of successful decannulation was 86.67%.The functional scores of the children after decannulation were improved compared with that before surgery(P<0.05).CONCLUSIONThe external cervical surgical approach that anterior split of cricoid cartilage plus free hyoid bone implantation plus T-tube placement is an effective way to treat subglottic stenosis in children.Early diagnosis and treatment is helpful to children’s airway development,physical and mental health,and reduce family financial burden.

关 键 词：舌骨 修复外科手术 治疗结果 获得性声门下狭窄 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]