婴幼儿舌甲状舌管囊肿44例临床特点和治疗效果分析

Clinical characteristics and therapeutic effect of 44 cases of lingual thyroglossal duct cyst in infants

目的探讨小儿舌甲状舌管囊肿(LTGDC)的临床特点和综合治疗效果。方法回顾分析44例小儿LTGDC的临床特点。所有患儿术前行常规电子纤维喉镜、喉部CT、放射性核素检查。常规经口切除后,行纤维喉气管镜检查和气管内插管(ETT)透气试验,并根据Cotton-Myer分级进行声门下狭窄的评估。结果临床主要表现为喉喘鸣22例、反复吸入性肺炎8例、呼吸困难等呼吸道症状6例和喂养困难等消化道症状4例。所有患儿经口切除囊肿,35例同时行声门上成形术。6例杓间隙深予以手术修补;Ⅱ度获得性声门下狭窄1例,抗酸治疗后拔管,未予手术处理。术后喉喘鸣的治愈率达86.4%(19/22),反复吸入性肺炎治愈6例,呼吸困难治愈5例,喂养困难治愈2例。1例伴神经肌肉疾病患儿,喂养困难无改善,持续鼻饲喂养。2例打鼾患儿,1例术后打呼症状基本消失。卵圆孔未闭患儿心脏手术后声嘶稍有好转,未影响呼吸。术后12~72h,并发术腔出血3例,均返回手术室止血,未再出现二次出血。术后1年内,1例复发,外院予以二次手术,未再复发。结论当患儿出现喉喘鸣、呼吸不畅、呛咳等症状,内科治疗的同时,应积极完善电子纤维喉镜、喉部CT检查,提高LTGDC的诊断率。术中切除囊肿的同时,行气管镜检查评估喉、气管发育情况,必要时配合抗酸等综合治疗,提高治愈率。

Objective To investigate the clinical features and comprehensive treatment of lingual thyroglossal duct cyst (LTGDC) in infants. Methods The clinical features of 44 cases of LTGDC in infants were analyzed retrospectively. All patients underwent routine preoperative electronic fibrolaryngoscopy, CT and isotope examination. Effectiveness criteria were based on the improvement of clinical symptom.Transoral excision after fibrolaryngoscope and ETT tests were performed to assess subglottic stenosis based on the Cotton-Myer grading system. Results The clinical features were larynx stridor in 22 cases, recurrent aspiration pneumonia in eight cases, dyspnea in six cases and feeding difficulty in four cases. All LTGDCs were resected by transoral excision. Cyst excision with supraglottic plasty was performed in 35 cases. One case of acquired subglottic stenosis Ⅱ, after acid-fast treatment, acquired successful extubation, without surgery. The cure rate of laryngeal stridor was 86.4%(19/22). Aspiration pneumonia was was cured in 6 cases, dyspnea was cured in 5 cases, of feeding difficulty was cured in 2 cases. In two infants with snoring, one case had no obvious improvement in the symptoms of dyspnea. Hoarseness improved slightly after cardiac surgery in infant with open foramen ovale and did not affect breathing. Within 12 to 72 hours after the operation, postoperative hemorrhage occurred in three cases, who were sent to the operating room to stop bleeding, and no bleeding occurred again. One case recurred within one year after the operation. Conclusions When infants have symptoms such as laryngeal stridor, dyspnea and so on, electronic fiberoptic laryngoscope and laryngeal CT should be used to improve the diagnostic rate. At the same time,tracheoscopy should be performed to evaluate the development of larynx and airway, and to improve the cure rate.