重度先天性喉软化的外科治疗(附16例报道)

Surgical management for severe congenital laryngomalacia:16 consecutive cases

目的:探讨重度先天性喉软化的诊治方法和疗效。方法:回顾性分析16例重度先天性喉软化患儿的临床表现、诊断、手术方法及术后随访资料。根据临床表现及电子喉镜检查确诊,并依据喉软化分型采取相应的声门上成形术。结果:16例患儿平均手术年龄为23周。14例行声门上成形术,2例伴气管软化者行气管切开术。声门上成形术后48h喉喘鸣消失9例,呼吸困难解除6例,喂养困难消失7例。术后6个月随访,1例患儿因重症肺炎死亡,其余13例中喉喘鸣消失12例,改善1例;呼吸困难解除8例;喂养困难消失12例,改善1例。结论:声门上成形术能有效缓解重度喉软化所致的喉喘鸣、呼吸及喂养困难等症状,可作为重度先天性喉软化的首选外科治疗方式。

Objective：Laryngomalacia is the most common cause for stridor in neonate and infant. Our study aims at assessing the outcome of surgical management in patients diagnosed by fibrolaryngoscopelas congenital la- ryngomalacia. Method：Retrospective study of 16 patients undergoing surgery for severe laryngomalacia. The pa- tients＇ symptoms, associated medical conditions and surgical management were recorded. Resalt：Stridor and feeding difficulty were observed in 16 patients on admission, while dyspnea was found in 11 patients. Medical co-morbidi- ties exist in 14 cases. The mean age of surgery was 23 weeks, 15 ,patients had follow-up records for 24 months. Fourteen cases underwent supraglottoplasty. Tracheotomy was performed on the other 2 cases complicated with tracheomalacia. Nine cases showed full recovery of stridor 48 hours post-supraglottoplasty, ;and 7 were free of feeding difficulties. In the 6 months＇ follow-up, complete or partial relief was achieved in all main symptoms and signs. Conclusion：Supraglottoplasty is effective in relieving stridor and feeding difficulty as well as respiratory in- sufficiency, which makes it a first line option for managing severe laryngomalacia.