胸舌骨肌皮瓣治疗儿童喉气管狭窄的临床应用

Sternohyoid myocutaneous flap in pediatric laryngotracheal stenosis treatment

目的:探讨胸舌骨肌皮瓣在儿童喉气管狭窄治疗中的作用和适应证。方法:回顾性分析1991-08-2014-10期间用胸舌骨肌皮瓣治疗的儿童喉气管狭窄病例20例。其中男15例,女5例;年龄3~14岁,平均9岁。严重程度按Myer-Cotton方法分,Ⅱ度4例,Ⅲ度10例,Ⅳ度6例。狭窄长度0.3~4.0cm,平均1.8cm。合并单侧声带麻痹3例,双侧2例。结果:拔管治愈14例,占70%;失败6例,占30%。其中Ⅱ度狭窄拔管率100%,Ⅲ度70%,Ⅳ度50%。结论:对于儿童喉气管狭窄病例,胸舌骨肌皮瓣是相对较安全有效的治疗方法。但对严重狭窄病例应慎重使用,其失败率较高。

Objective：To assess the indications and outcomes of laryngotracheal reconstruction（LTR）using the sternohyoid myocutaneous flap（SMF）in pediatric patients with laryngotracheal stenosis.Method：Twenty patients（15 males,5 females;mean age,9 years old,range 3 to 14）with laryngotracheal stenosis who underwent SMF procedures at Tangdu Hospital between August 1991 and October 2014 were analyzed.Stenosis was classified according to the Myer-Cotton grading system.Four patients were gradeⅡ,ten were gradeⅢ,and six were gradeⅣ.The mean length of stenosis was 1.8 cm（rang,0.3-4.0 cm）.Three patients had concomitant unilateral vocal paralysis and 2 had bilateral vocal paralysis.Result：Fourteen of 20 patients（70%）were decannulated.The prevalence of decannulation for gradeⅡ,Ⅲ,and Ⅳ was 100%,70%,and 50%,respectively.There were no severe complications.Conclusion：The SMF is a relatively simple and reliable method for LTR but should be used cautiously if employed in severe cases such as gradeⅣ with long-segment stenosis.