喉显微外科技术在严重新生儿上气道梗阻中的应用

Application of laryngeal microsurgery in severe neonatal upper airway obstruction

目的 探讨严重新生儿上气道梗阻病因、临床特征及喉显微外科手术疗效,以提高新生儿阻塞性呼吸困难的诊治水平。方法 采用观察性研究,分析16例咽喉相关的严重上气道梗阻新生儿临床资料。结果 共纳入患儿16例(男9例、女7例),出生后7~28 d出现临床症状,包括吸气性呼吸困难、喉喘鸣、三凹征等。其中先天性喉软化症6例、下咽及舌根囊肿3例、喉部血管瘤2例、喉入口畸胎瘤1例、先天性喉蹼1例、双声带麻痹1例、继发性声门下狭窄1例、插管后喉粘连1例。16例患儿均给予相应显微外科治疗,手术顺利。顺利拔管患儿15例,仅1例喉软化症患儿拔管后仍有明显呼吸困难,行气管切开。结论 严重新生儿上气道梗阻多与咽喉病变相关,需早期行局部及全身检查明确病因及诊断,对有手术指征者积极采取微创手术治疗,可挽救患儿生命,取得满意疗效。

Objective The aim of this study was to explore the etiology, clinical features, and the microsurgery efficacy of severe neonatal upper airway obstruction, to achieve better diagnosis and treatment of neonatal obstructive dyspnea. Methods An observative research was conducted enrolling 16 neonates with severe throat-related upper airway obstruction. Results A total of 16 neonates(9 males and 7 females) were registered, whose clinical symptoms appeared 7-28 days after birth and included inspiratory dyspnea, stridor, and the three-concave sign. Patients were classified as follows: 6 cases of congenital laryngomalacia;3 hypopharynx and tongue root cysts;2 laryngeal hemangiomas;1 laryngeal entrance teratoma;1 congenital laryngeal webbing;1 bilateral vocal cord paralysis;1 secondary subglottic stricture;1 laryngeal adhesion after intubation. All 16 neonates were treated with appropriate microsurgery, and all operations went smoothly. Altogether, 15 neonates were extubated smoothly, except for 1 case of laryngomalacia in which a tracheotomy was performed. Conclusion Severe neonatal upper airway obstruction is mostly frequently related to laryngopharynx lesions. Early local and systemic examinations are required to confirm the cause and diagnosis. Timely minimally invasive surgery for patients with surgical indications can achieve satisfactory results and save their lives.