小儿软骨性声门下蹼的诊断和治疗

Diagnosis and treatment of the cartilaginous subglottic web in children

目的探讨小儿声门下蹼的诊断、评估及手术治疗。方法总结2014年8月~2018年3月收治的4例小儿软骨性声门下蹼患儿资料,其中诊断为先天性喉蹼Ⅳ型1例,Ⅲ型3例,行全麻下喉裂开+软骨性蹼黏膜下切除+临时支撑管治疗。结果 3例患儿术前气管切开,切开时间分别为13、13、6月龄,1例患儿术中气管切开。2例留置临时支撑管于术后7、11天自行拔除,2例术后14天由医师拔除。4例均在支撑管拔除当天即行气管堵管成功,经3~5个月持续堵管后顺利拔除套管。结论对小儿先天性软骨性喉蹼Ⅲ或Ⅳ型,采用喉裂开+软骨性蹼黏膜下切除+临时支撑管的方法效果良好,短期拔管率高,无并发症。

OBJECTIVE To explore the methods of preoperative diagnosis, evaluation and surgical treatment of the subglottic web in children. METHODS We analyzed the clinical manifestations, electronic laryngoscopy results,tracheal endoscopy and airway CT results of 4 children cases with congenital laryngeal cartilaginous subglottic web（1 case of type IV and 3 cases of type III） from August2014 to March 2018. All of the 4 patients underwent a laryngofissure plus submucosal resection of cartilage web and short-term stenting. RESULTS Two cases underwent preoperative tracheotomy at 13 month old, 1 case at 6 month old. One case underwent tracheotomy at the same time of laryngoplasty. Two children indwelled the stents for 7 days and 11 days after operation and removed the stent by themselves. Other 2 cases removed the stent by the doctor at14 day after operation. After removing the stents, the 4 cases underwent a pluging of the tracheotomy instantaneously.After 3 to 5 months of continuously pluging of the tracheotomy, all cases successfully removed the tracheal cannula. CONCLUSION For children with congenital laryngeal cartilaginous subglottic web of type III or type IV,the operation of laryngofissure plus submucosal resection of cartilage web and short-term stenting is the good choice with a high extubation rate and no complications.