婴幼儿喉蹼的诊断与治疗

Diagnosis and treatment of laryngeal web in infants

目的总结各种类型婴幼儿喉蹼的临床表现、手术方法及疗效。方法分析12例婴幼儿喉蹼的临床资料，其中先天性喉蹼5例（4例声门型，1例声门下型）；继发性喉蹼7例（1例结核性喉蹼，6例创伤性喉蹼）。诊断主要依靠病史和临床表现，确诊通过纤维喉镜的检查和病理检查。治疗主要依靠支撑喉镜下进行喉显微手术，激光或微波是必要的辅助技术，特异感染者需先治愈原发疾病后，再考虑手术。结果先天性喉蹼随诊3个月～1年半，4例声门型喉蹼术后无粘连，无复发，发音清晰，手术效果好；另1例声门下型，暂不需手术。结核性喉蹼1例随诊半年，声带无粘连，发音清晰，未见肺结核复发。6例创伤性喉蹼均为喉乳头状瘤患儿，术后随诊3～6个月，1例未见复发，5例均复发需再次手术。结论先天性喉蹼确诊依靠纤维喉镜，手术效果好，无复发，不需放置喉模。结核性喉蹼需病理诊断，早期原发病的诊疗十分重要。继发于喉乳头状瘤的创伤性喉蹼，手术效果不甚理想，提高手术技巧，掌握最佳手术时机可能会减少复发机会。

Objective To summarize the clinical manifestation, operative method and therapeutic effect of various type of laryngeal web in infants. Methods The clinical data of 12 cases were analyzed, 5 cases of which were congenital laryngeal web （4 cases, glottic type; 1 case, subglottic type）, 7 cases of which were secondary laryngeal web （1 case, tuberculous laryngeal web; 6 cases, traumatic laryngeal web）. Diagnosis was mainly depended on history and clinical manifestation. Final diagnosis was depended on fibrolaryngoscope and pathological report. Microlaryngoscopic surgery was the main operative method. However, specific infection should be cured before opration. Results During 3-18 months follow-up, 4 glottic laryngeal webs were cured. One subglottic laryngeal web case well recorered and secondary surgery isnot needed at least recently. One tuberculous laryngeal web was followed up for 6 months, no vocal adhesion was observed. During 3-6 months follow-up, 1 traumatic laryngeal web was cred, While the other 6 cases need secondary surgery. Conclusions Final diagnosis of congenital laryngeal web is mainly depended on fibrolaryngoscope. And prognosis of it is well. Laryngeal web induced by specific infection should be cured specific infection before opration. The prevention is the key for traumatic laryngeal web because the surgery outcome is not satisfactory.