经支撑喉镜的内镜技术在儿童Ⅲ型喉裂的应用  

Application of endoscopic surgical repair through bracing laryngoscope in children with typeⅢlaryngeal clefts

作　　者：黄一天 姚红兵[1] 唐新业[1] 杨阳[1] HUANG Yitian;YAO Hongbing;TANG Xinye;YANG Yang(Department of Otolaryngology Head and Neck Surgery Children's Hospital of Chongqing Medical University,National Clinical Research Center for Child Health and Disorders,Ministry of Education Key Laboratory of Child Development and Disorders,Chongqing Key Laboratory of Pediatrics,Chongqing,400014,China)

机构地区：[1]重庆医科大学附属儿童医院耳鼻咽喉头颈外科、国家儿童健康与疾病临床医学研究中心、儿童发育疾病研究教育部重点实验室、儿科学重庆市重点实验室,重庆400014

出　　处：《临床耳鼻咽喉头颈外科杂志》2023年第12期948-952,共5页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:分析内镜下喉裂修补术治疗Ⅲ型喉裂的疗效,探讨该术式治疗Ⅲ型喉裂的可行性。方法:回顾分析2018年6月—2023年1月共6例于我科接受内镜下喉裂修补术的Ⅲ型喉裂患儿临床资料。手术在静脉复合全身麻醉下进行,保留患儿的自主呼吸,在4 mm/0°内镜辅助下使用射频刀或喉剪沿喉裂边缘黏膜制作新鲜创面,用6-0 PDP缝线根据喉裂的范围情况缝合3~6针,术后3个月行改良吞钡检查评估吞咽功能。结果:所有患儿均成功接受内镜下喉裂修补术,2例术后转入儿科重症监护室进行为期7 d的监护,其余患儿术后均转回普通病房,术后均无手术并发症发生。所有患儿吞咽障碍、喉鸣、反复肺炎的症状均得到改善,术后改良吞钡检查随访结果所有患儿均无误吸,有2例患儿在大口喝水时出现间歇性咳嗽。随访过程中有2例复发,经过第2次内镜下修补治疗后裂隙完全修复,随访至今未再复发。结论:内镜下喉裂修补术可以适用于部分Ⅲ型喉裂的患儿,术中出血量少,手术并发症少,术后能明显改善患儿吞咽功能障碍、反复肺炎等症状,是一种安全且有效的手术方案。Objective:To analyze the efficacy of endoscopic surgical repair in the treatment of typeⅢlaryngeal clefts and to explore the feasibility of the treatment for typeⅢlaryngeal clefts.Methods:The clinical data of 6 children with typeⅢlaryngeal clefts who underwent endoscopic surgical repair 0.5 c356 in our department from June 2018 to January 2023were analyzed retrospectively.The operation was performed under combined intravenous and general anesthesia,preserving the spontaneous breathing of the children.With the assistance of 4mm/0°endoscope,radiofrequency knife or laryngeal scissors were used to make fresh wounds along the edge of laryngeal clefts,and cotton pads infiltrated with adrenaline(1:10000)were used to compress the wound.6-0PDP suture was used to suture 3-6stitches according to the extent of laryngeal clefts.Modified barium swallowing test(MBS)was performed 3months after operation.Results:All the children were successfully treated with endoscopic surgical repair.After surgery,2cases were transferred to pediatric intensive care unit(ICU)for 7days of monitoring,and the rest d dwere transferred back to the general ward.There were no postoperative complications.The symptoms of dysphagia,laryngitis and recurrent pneumonia were improved in all children.According to the follow-up results of postoperative MBS,no aspiration was found in all children,and 2children had intermittent cough when drinking large amounts of water.During the follow-up,there were 2cases of recurrence,and the cracks were completely repaired after the second endoscopic surgical repair treatment,and no recurrence has been observed so far.Conclusion:Endoscopic surgical repair can be applied to some children with typeⅢlaryngeal clefts with less intraoperative bleeding and fewer operative complications.It can significantly improve the symptoms such as swallowing dysfunction and recurrent pneumonia.It is a safe and effective surgical treatment.

关 键 词：Ⅲ型喉裂 儿童 内镜下喉裂修补术 

分 类 号：R767.7[医药卫生—耳鼻咽喉科]