球囊扩张喉气管成形术治疗婴幼儿继发性声门下狭窄的效果分析  

Outcomes of endoscopic balloon dilation laryngoplasty for acquired subglottic stenosis in children

作　　者：李琪 王鹏程 倪祎华 谭乐恬 许政敏[1] 陈超[1] LI Qi;WANG Pengcheng;NI Yihua;TAN Letian;XU Zhengmin;CHEN Chao(Department of Otorhinolaryngology Head and Neck Surgery,Children's Hospital of Fudan University,Shanghai,201102,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201102

出　　处：《临床耳鼻咽喉头颈外科杂志》2025年第2期124-127,共4页Journal of Clinical Otorhinolaryngology Head And Neck Surgery

摘　　要：目的:探讨内镜下球囊扩张技术治疗继发性声门下狭窄的效果。方法:回顾性分析复旦大学附属儿科医院耳鼻咽喉头颈外科2017年1月—2024年1月期间采用内镜下球囊扩张技术治疗的继发性声门下狭窄病例的临床资料。共10例患儿纳入研究,其中男6例,女4例。首次扩张时年龄13 d~3岁,平均7个月。声门下狭窄程度按Myer-Cotton分级:Ⅱ度2例,Ⅲ度8例。所有患儿均有气管插管史,其中7例因抢救需要行气管插管,3例因手术需要行气管插管。8例患儿合并其他疾病,2例合并房间隔缺损、动脉导管未闭及卵圆孔未闭,2例合并卵圆孔未闭,1例合并房间隔缺损及左耳极重度聋,1例合并脑肿瘤及脑积水,1例合并创伤性膈破裂膈疝及肝破裂,1例合并Ⅰ型喉裂。术前所有患儿均需要呼吸支持,7例需要高流量吸氧,3例需要无创呼吸支持。结果:10例患儿均保留自主呼吸全身麻醉下行内镜下球囊扩张术,共扩张14次,平均1.4次/例,无并发症出现;所有患儿术后再次行透气试验评估声门下狭窄情况,Ⅰ度狭窄8例,Ⅱ度狭窄2例。随访6个月~6年8个月,平均46个月。患儿均脱离呼吸支持,且无明显活动受限。结论:保留自主呼吸全身麻醉下内镜下球囊扩张技术治疗继发性声门下狭窄安全有效,尽早明确诊断并治疗能够避免气管切开。标准的气管镜检查联合透气试验,评估气道管径,减少或避免气管插管后继发性声门下狭窄的发生是更重要的治疗措施。Objective To investigate the outcomes of endoscopic balloon dilation laryngoplasty(EBDL)in managing acquired subglottic stenosis in children.Methods A retrospective analysis of clinical data from patients who underwent endoscopic balloon dilation for secondary subglottic stenosis between January 2017 and January 2024 at Department of Otorhinolaryngology Head and Neck Surgery,Children's Hospital of Fudan University,Shanghai.The study included 10 children(6 males,4 females)aged between 13 days and 3 years at the time of their first procedure,with an average age of 7 months.Subglottic stenosis was graded according to the Myer-Cotton classification,with two cases classified as grade Ⅱ and eight cases as grade Ⅲ.All patients had a history of tracheal intubation,including seven for rescue purposes and three for operations.Eight cases were complicated by other conditions:two with atrial septal defect,patent ductus arteriosus,and patent foramen ovale;two with patent foramen ovale only;one with atrial septal defect and extreme deafness in the left ear;one with a brain tumor and hydrocephalus;one with a traumatic diaphragmatic hernia and hepatic rupture;and one case complicated by type Ⅰ laryngeal cleft.Prior to surgery,all children required respiratory support-seven needed high-flow oxygen while three required CPAP.Results All ten cases underwent endoscopic balloon dilation under spontaneous respiration and general anesthesia,totaling fourteen dilations(an average of 1.4 dilations per person)without any complications.Post-surgery air permeability tests showed that eight cases had gradeⅠstenosis while two had gradeⅡstenosis.The follow-up period ranged from six months to six years(average duration:46 months).Following treatment,all patients no longer required respiratory support or experienced significant mobility limitations.Conclusion Endoscopic balloon dilation under general anesthesia is deemed safe and effective in treating secondary subglottic stenosis.Early diagnosis coupled with prompt intervention can hel

关 键 词：声门下狭窄 球囊扩张 喉气管成形术 内镜下 

分 类 号：R767.4[医药卫生—耳鼻咽喉科]