小儿重度喉软化症临床特点及手术疗效影响因素分析

Analysis of clinical characteristics and surgical efficiency of severe laryngomalacia in children

目的:探讨重度喉软化症患儿的临床特点及影响手术疗效的因素。方法:回顾性分析2015年1月-2019年5月在重庆医科大学附属儿童医院进行声门上成形术的重度喉软化症患儿的临床资料,探讨重度喉软化症患儿的临床特点,评估术后不同时期主要症状的改善情况,分析手术年龄和医学共病对手术疗效的影响。结果:在重症喉软化的解剖分型中,Ⅳ型所占比例最高(37例,66.1%),Ⅰ型最少(2例,3.6%);所有患儿均存在喉鸣和呼吸困难,其次是喂养困难(46例,82.1%)和生长发育不良(38例,67.9%)。56例重度喉软化症患儿中,伴有医学共病的患儿35例(62.5%),先天性心脏疾病22例(39.3%),发病率最高。不伴医学共病的重度喉软化症手术有效率为100.0%,伴一种类型共病的手术有效率为96.0%,伴多种类型共病的手术有效率为30.0%(P<0.01)。绝大多数患儿的喉鸣、呼吸困难、喂养困难在术后1个月可以得到明显改善。手术年龄<3个月,伴共病组术后1、3、6个月的手术有效率分别为61.5%、61.5%、69.2%,不伴共病组术后1、3、6个月的手术有效率均为100.0%,两者比较差异无统计学意义(P>0.05);手术年龄>3个月,无论是否伴有共病,术后1、3、6个月的手术有效率均为100.0%。不伴共病患儿的手术失败率和再手术率均为0,而伴共病患儿的手术失败率和再手术率分别为22.9%和20.0%,两者比较差异有统计学意义(P<0.05),其中伴多种共病患儿的手术失败率及再手术率显著高于伴一种共病的患儿(70.0%和4.0%,60.0%和4.0%),两者比较差异有统计学意义(P<0.01)。重度喉软化症总体手术成功率为85.7%。结论:大部分重度喉软化症患儿伴有不同类型和数量的共病,有着更复杂的解剖分型。声门上成形术可改善绝大部分患儿的喉鸣、呼吸困难、喂养困难及生长发育不良,手术成功率高;手术疗效不受手术年龄的影响;多种共病的存在是手术失败和再手术的主要原因。

Objective:To analyze the clinical characteristics and factors affecting surgical efficiency in children with severe laryngomalacia.Methods:Retrospectively collect medical records of children with severe laryngomalacia who underwent supraglottoplasty in Children’s Hospital of Chongqing Medical University between January 1,2015 and May 1,2019.And analyze the clinical characteristics,the improvement of main symptoms at different time points,and the influence factors on the surgical efficiency.Results:According to the anatomical classification of severe laryngomalacia,typeⅣaccounted for the highest proportion(66.1%),and typeⅠwas the lowest(3.6%).All children had stridor and dyspnea,82.1%cases presented feeding difficulties,and 67.9%cases presented failure to thrive.The proportion of children with medical comorbidities was 62.5%,of which congenital heart disease had the highest incidence(39.3%)The surgical efficiency of severe laryngomalacia without comorbidities was 100.0%,with one type of comorbidity was 96.0%,with multiple comorbidities was 30.0%(P<0.01).Stridor,dyspnea,feeding difficulties were significantly improved at one month after surgery in most cases.In the group of surgical age less than 3 months,the surgical efficiency were 61.5%,61.5%and 69.2%at 1,3,6 months after surgery,respectively;the surgical efficiency of children without comorbidities were 100.0%(P>0.05)at 1,3,6 months after surgery.In the group of surgical age older than 3 months,the surgical efficiency of children were 100.0%at 1,3,6 months after surgery regardless with or without comorbidities.The surgical failure rate and reoperation rate in children without comorbidities was 0,but in the children with comorbidities were 22.9%(P<0.05)and 20.0%(P<0.05),respectively.The surgical failure rate and reoperation rate in children with multiple comorbidities was significantly higher than children with only one comorbidity(70.0%vs.4.0%;60.0%vs.4.0%,P<0.01).The overall operation success rate was 85.7%in severe laryngomalacia children in our hospital.Conclusion:Most children with severe laryngomalacia are associated with multiple medical comorbidities,and with more complex anatomical types.Supraglottoplasty can effectively improve the symptoms in most children with severe laryngomalacia.The existence of multiple comorbidities is the main cause of surgical failure.