前后肋软骨支架移植喉气管重建术治疗儿童重度声门下狭窄或喉蹼的效果分析  

Outcomes of laryngotracheal reconstruction with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis or laryngeal web

作　　者：谭乐恬 谢毅 李琪 陈超[1] Tan Letian;Xie Yi;Li Qi;Chen Chao(Department of Otorhinolaryngology Head and Neck Surgery,Children′s Hospital of Fudan University,Shanghai 201100,China;Department of General Surgery,PLA Naval medical center,Shanghai 200052,China)

机构地区：[1]复旦大学附属儿科医院耳鼻咽喉头颈外科,上海201100 [2]解放军海军特色医疗中心普外科,上海200052

出　　处：《中华耳鼻咽喉头颈外科杂志》2023年第7期699-704,共6页Chinese Journal of Otorhinolaryngology Head and Neck Surgery

摘　　要：目的探讨前后肋软骨支架移植喉气管重建术治疗重度声门下狭窄或喉蹼的手术效果。方法回顾性分析2020年1月至2022年1月复旦大学附属儿科医院耳鼻咽喉头颈外科诊断为重度声门下狭窄或喉蹼并接受前后肋软骨支架移植喉气管重建术治疗的病例资料。患儿共8例,男7例,女1例;手术时年龄最小2岁,最大9岁,中位年龄6岁。声门下狭窄6例,按Cotton分级均为Ⅲ度,其中原发性1例,继发性5例;喉蹼2例,按Cohen分型为Ⅲ型。4例患儿术前已行气管切开。术后的随访评估包括手术部位、呼吸状态、吞咽功能、嗓音及并发症等。采用描述性方法进行分析。结果所有病例行一期或二期前后肋软骨支架移植喉气管重建术,一期手术5例,二期手术3例。7例患儿成功拔管,呼吸状态、吞咽功能均正常,4例存在轻度声音嘶哑,3例存在中度声音嘶哑;1例拔管失败再次气管切开。结论前后肋软骨支架移植喉气管重建术是治疗重度声门下狭窄或喉蹼有效的术式,合理选择手术分期能取得更好的效果。Objective To investigate outcomes of laryngotracheal reconstruction(LTR)with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis(SGS)or laryngeal web(LW).MethodsA review of patients with severe subglottic stenosis or laryngeal web between January 2020 and January 2022 was performed.Demographic features including gender,age at diagnosis,age at surgery,etiology,airway support,and other comorbidities were collected preoperatively.Patients were evaluated in surgical site,breathing,swallowing,phonation and complications postoperatively.Descriptive analysis was used in this research.ResultsEight patients were included:six with gradeⅢSGS following Cotton-Myer grading scale,and two with type Ⅲ LW following Cohen′s classification.All patients underwent LTR with anterior and posterior costal cartilage grafts.Five patients underwent single-stage LTR(ssLTR),and three patients underwent double-stage LTR(dsLTR).Seven out of eight patients were able to successfully extubate or decannulate with normal swallowing function;four patients had mild hoarseness,and three had moderate hoarseness.One patient failed in extubation,and underwent tracheotomy.ConclusionsLTR with anterior and posterior costal cartilage grafts is an effective and safe treatment for severe SGS or LW.Careful preoperative assessment of disease severity and overall medical status will help selection between ssLTR and dsLTR,thereby maximizing patient outcomes for both modalities.

关 键 词：喉气管重建术 儿童 肋软骨支架 声门下狭窄 喉蹼 

分 类 号：R767.91[医药卫生—耳鼻咽喉科]