先天性肥厚性幽门梗阻合并先天性喉软骨发育不良患儿手术的麻醉管理

Anesthetic management of congenital hypertrophic pyloric stenosis combined with congenital laryngeal cartilage dysplasia in children

目的探讨先天性肥厚性幽门梗阻（CHPS）合并先天性喉软骨发育不良患儿手术的麻醉管理方法，为易发生呼吸道塌陷患儿的麻醉管理提供参考。方法选择2016年3月15日，于四川大学华西医院儿外科收治的1例CHPS合并喉软骨发育不良患儿作为研究对象。对其采取喉面罩通气道（LMA）全身麻醉复合超声引导下骶管阻滞麻醉，并拟对其进行腹腔镜下幽门环肌切开术治疗。由于考虑腹腔镜的气腹压力，可增加胃内容物反流误吸的风险，故修改手术方案为开腹幽门环肌切开术。回顾性分析本例患儿的临床特征及开腹幽门环肌切开术麻醉管理经过。结果本例患儿的麻醉效果满意，顺利完成开腹幽门环肌切开术。手术结束10min后，患儿清醒，遂拔除LMA导气管，无不良事件发生。患儿术后于重症监护病房（ICU）接受治疗期间，无呼吸道问题发生，术后7d出院。术后1年电话随访，其父诉患儿喉鸣症状于患儿6个月龄左右时逐渐消失，患儿生长发育良好。结论LMA全身麻醉复合超声引导下骶管阻滞麻醉，可以满足本例CHPS合并先天性喉软骨发育不良患儿的手术麻醉需求，并减少其呼吸道不良事件的发生。

Objective To investigate anesthetic management of congenital hypertrophic pyloric obstruction （CHPS） combined with congenital laryngeal cartilage dysplasia in children, in order to provide reference for the anesthetic management of children with respiratory tract collapse. Methods On 15 March 2016, one child suffering from CHPS combined with congenital laryngeal cartilage dysplasia who was treated in Pediatric Surgery Department of West China Hospital of Siehuan University was selected as the subject. Under general anesthesia with laryngeal mask airway （LMA） combined with sacral block anesthesia guided by ultrasound, the treatment strategy for this child laparoscopic pyloromyotomy should be performed. Considering the risk of reflux aspiration would be increased by pneumoperitoneum pressure of laparoscopy, open pyloromyotomy for CHPS combined with congenital laryngeal cartilage dysplasia was performed finally. The clinical features and anesthetic management of this child were analyzed retrospectively. Results The anesthetic effect of this child was satisfactory and the open pyloromyotomy for CHPS combined with congenital laryngeal cartilage dysplasia was successful. About 10 min after surgery, this child was conscious and catheter of LMA was removed without any adverse events. During the treatment period of this child in intensive care unit （ICU） after surgery, there was no respiratory problems occurred. And this child discharged from hospital on the 7th day after surgery. One year after surgery, father of this child confirmed that laryngeal symptoms of this child disappeared gradually at 6 month old, and this child had good growth and development by telephone follow-up. Conclusions The method of LMA general anesthesia with caudal block could match the requirement of open pyloromyotomy of this child suffering from CHPS combined with congenital laryngeal cartilage dysplasia, and reduce the incidence of respiratory adverse events.