婴幼儿声门下血管瘤切吸术疗效的初步观察

Treatment of infantile subglottic hemangioma by microdebrider

目的 探讨婴幼儿声门下血管瘤采用切吸术治疗的安全性及疗效.方法 回顾性分析2009年1月至2012年12月采用动力吸割器行切吸术治疗的15例先天性声门下血管瘤患儿,发病年龄43天～5个月,其中出生后1周即出现喉喘鸣症状的7例,3～6周出现喉喘鸣症状的8例.安静时喉梗阻Ⅱ度,活动后或并上呼吸道感染后喉梗阻加重Ⅲ度8例;带气管插管入院7例.单侧14例,双侧1例.仅声门下单一病灶13例,合并颌面部多发性病灶2例.5例经系统口服激素或普萘洛尔治疗8～12周,效果不佳,再选择手术治疗.15例均采用全身麻醉（吸入诱导及静脉麻醉维持,保留自主呼吸）下血管瘤切吸术,术前、术后均未行气管切开.结果 15例中早期6例术中瘤体未取活组织病理检查,9例术中留取瘤体组织,术后经病理检查证实为毛细血管瘤.术中出血量1～3 ml,其中5例出血较多的为2～3 ml;平均约2～3 ml,手术时间10～ 15 min.13例术中呼吸平稳,血氧饱和度维持0.95以上,2例有短暂血氧饱和度下降（0.75 ～0.80）经插管吸除下气道分泌物后,恢复正常.5例术后带管入儿童重症监护室观察,24～48 h后顺利拔管返回普通病房.10例术后麻醉苏醒后立刻拔管返回普通病房观察.术后喉喘鸣、喉梗阻症状即刻缓解的10例,24～ 48 h缓解5例.无一例因局部水肿而再次插管或气管切开.随访10～18个月,未见复发及并发症.结论 婴幼儿先天性声门下血管瘤应掌握个体化治疗原则.切吸术具有微创、安全、疗程短、围手术期并发症少的特点,对瘤体较大阻塞气管径≥50％,且在上呼吸道感染时反复发作急性喉梗阻的患儿,在麻醉师的良好配合下可酌情选择.

Objective To investigate the clinical features,minimally invasive treatment,and outcomes of subglottic hemangioma in infants.Methods Fifteen cases of infantile subglottic hemangioma treated from January 2009 to December 2012 were retrospective analysed.Average time of onset was within 43 days-5 months of age.Seven cases had symptoms of laryngeal obstruction one week after birth,and 8 cases had symptoms within three weeks to six weeks after birth.Fourteen cases were unilateral and 1 case bilateral.No case had tracheotomy.Seven cases were hospitalised after intubation.Of which 5 cases with subglottic hemangiomas who failed to respond to pharmacologic treatment were treated by microdebrider under suspension laryngoscope.Ten cases accepted suction cutter suction.Results After surgery,nine cases were confirmed pathologically as capillary hemangioma.Average bleeding was 1-3 ml during operation,surgery usually lasted 10-15 minutes.No complications were found.Five cases required orotracheal intubation for 24 or 48 h after surgery,and no reintubation or tracheotomy was required in this series.Symptoms such as stridor and inspiratory retraction resolved approximately 12-72 h after surgery.Follow-up was 12-18 months after surgery,no systemic or local complications were observed,and no recurrence.Conclusions The treatment of subglottic hemangioma is individualised.If the tracheal stenoses ≥50％,with recurrent infection and acute laryngeal obstruction,removal of tumor with microdebrider is the minimally invasive,safe,simple and effective method with less complications.It is important that the anaesthetist should work well with otolaryngologist during operation.