多手段联合手术策略在儿童难治性喉气道梗阻中的应用

Application of multimodal combined surgical strategy in children with intractable laryngeal airway obstruction

目的探讨多手段联合治疗儿童难治性喉气道梗阻手术方法的选择和术中策略,为儿童难治性喉气道梗阻的诊治提供新的选择。方法回顾性分析2005年1月—2021年12月收治的12例儿童难治性喉气道梗阻患儿的临床资料。所有患儿均在硬质气管镜或支撑喉镜联合电子内镜下行微创手术治疗,手术方法包括喉显微器械、等离子消融术、球囊扩张术、药物支架植入、激光消融、高频圈套器圈套等。术后进行随访。结果所有患儿均在全身麻醉下完成手术,术中及术后无并发症发生。除1例双侧声带麻痹患儿因术后创面再次狭窄未能成功拔管外,其余均术后顺利拔管。其中9例良性占位性质的梗阻患儿随访5~60个月未见复发,2例恶性肿瘤(腺泡细胞癌和黏液表皮样癌)致梗阻的患儿分别随访24个月和36个月未见复发。结论内镜下多手术联合治疗对儿童难治性喉气道梗阻有效,与传统开胸手术比较具有创伤小、快捷、安全等优点。对于不同大小、位置及病理类型的梗阻应联合采用不同的手术方式及设备。

Objective To explore the selection of surgical methods and intraoperative strategies for the treatment of children with intractable laryngeal airway obstruction,and to provide new options for the diagnosis and treatment of children with intractable laryngeal airway obstruction.Methods The clinical data of 12 children with intractable laryngeal airway obstruction treated by our team from January 2005 to December 2021 were retrospective analyzed.All the children were treated with minimally invasive surgery under rigid bronchoscope or suspension laryngoscope combined with electronic endoscope.The surgical methods included laryngeal microsurgery,plasma ablation,balloon dilatation,drug-eluting stents,laser ablation,endoscopic snare,etc.The patients were followed up after operation.Results All patients completed the operation under general anesthesia,and there were no intraoperative or postoperative complications.Except for one patient with bilateral vocal cord paralysis who failed to extubation due to restenosis,the others were successfully extubated after operation.Among them,9 cases of benign space-occupying obstruction were followed up for 5-60 months without recurrence,and 2 cases of malignant tumor-induced obstruction were followed up for 24 months(acinar cell carcinoma)and 36 months(mucoepidermoid carcinoma)without recurrence.Conclusion Endoscopic multi-operation is effective for children with intractable obstruction.Compared with traditional thoracotomy,endoscopic multi-operation strategies has the advantages of less trauma,faster and safer.For different sizes,locations and pathological types of obstruction,different surgical equipment and methods should be combined.