支气管镜下综合介入治疗儿童插管后声门部及声门下狭窄28例

Comprehensive Interventional Bronchoscopic in treatment of glottis and subglottic stenosis after intubation in 28 children

目的探讨电子支气管镜下综合治疗儿童插管后声门部及声门下狭窄的价值。方法回顾性分析2012年1月至2015年1月山东大学齐鲁儿童医院住院的插管后声门部及声门下狭窄患儿28例临床资料。其中男13例，女15例；年龄13d～9岁。病例均在颈部＋胸部CT＋支气管镜下诊断，行电子支气管镜下吸引、激光、钳夹、球囊扩张呼吸道成形术等综合治疗。根据患儿呼吸状态改善情况、内镜下所见对狭窄部位和严重程度进行术前、术后评估。所有患儿接受6—12个月的随访。结果28例患儿均顺利拔管撤机，通过6～12个月随访，吸气性呼吸困难、声音嘶哑、喉鸣等症状明显改善，内镜下最狭窄处明显增宽，其中17例已达临床治愈，治疗次数约6次／例；7例临床症状好转，顺利拔管，目前尚在随诊中；2例新生儿期患儿声带充血、水肿明显，声门裂隙窄，未特殊介入处理，顺利拔管，目前临床观察中；2例因家长原因放弃治疗。患儿均未见严重出血、呼吸功能不全及窒息等并发症。结论支气管镜下综合治疗是解决儿童声门部及声门下狭窄有效、安全的方法之一。

Objective To discuss the effect of electronic bronchoscopy comprehensive therapy in the diagnosis and treatment of glottis and subglottic stenosis after intubation in children. Methods The records of 28 children diagnosed as glottis and subglottic stenosis after intubation by bronchoscopy in Qilu Children＇s Hospital of Shandong University from January 2012 to January 2015 were reviewed. They all had the neck and chest CT, bronchoscopic diagnostics, and received comprehensive treatment of laser, forceps, balloon angioplasty under electronic bronchoscopy, preoperative and postoperative evaluation was performed according to the improvement of respiratory status and endoscopic findings. All patients were followed up for 6 - 12 months. Results These 28 children were successfully extubated, and inspiratory dyspnea,hoarseness, and other symptoms were improved, endoscopic narrowest part was widened by 6 - 12 months of follow- up,including 17 cases reached clinical cure,about 6 times per patient;7 cases were successfully extubated and still in follow-up currently;2 cases of neonatal infants were extubated successfully, but they had vocal congestion, edema, glottis narrow fissure without special intervention, and were under clinical observation currently ;2 cases gave up treat- ment because of the other problems. All patients had no serious bleeding, respiratory insufficiency or other complications. Conclusions Electronic bronchoscopic comprehensive treatment is an effective and safe method to treat glottis and subglottic stenosis after intubation in children.