婴儿喉软化症临床特点及预后转归分析

Analysis of clinical characteristics and prognosis of infantile laryngomalacia

目的:分析婴儿喉软化症(ILM)的临床特点及预后转归。方法:收集2013年12月至2021年1月在广西医科大学第一附属医院儿科经支气管镜确诊ILM的住院患儿76例。根据ILM患儿的病情严重程度分为轻中度组36例和重度组40例;根据合并症分为有同步气道病变组(SALs组)40例和无SALs组36例、有神经肌肉发育异常组(NMD组)35例和无NMD组41例、有先天性心脏病组(CHD组)40例和无CHD组36例、有先天综合征组(CS组)23例和无CS组53例。回顾性分析各组临床特点,随访出院后症状改善情况以及重度ILM术后转归情况。结果:与重度组比较,Ⅱ型ILM在轻中度组的所占比例较高(P<0.05)。重度组出院后半年生长发育不良(FTT)改善率低于轻中度组(13.8%vs 53.3%, P<0.05),而出院后1年差异无统计学意义(P>0.05)。NMD组出院后1年FTT改善率低于无合并NMD组(32.0%vs 73.7%, P<0.05)。在重度ILM患儿中,共有12例进行了支气管镜介入手术,其中声门上成形术6例,喉咽部/会厌肿物/囊肿切除术6例,两种术式术后患儿的临床症状均得到缓解。结论:合并NMD对ILM患儿生长发育影响较大;重度ILM早期及时干预可较早改善临床症状;选择手术方式应个体化。

Objective:To analyze the clinical characteristics and prognosis of infantile laryngomalacia(ILM).Methods:A total of 76 hospitalized children with ILM diagnosed by bronchoscope in the Department of Pediatrics of the First Affiliated Hospital of Guangxi Medical University from December 2013 to January 2021 were collected.Children were divided into mild-moderate group(n=36)and severe group(n=40)according to the severity of ILM;according to the comorbidities,they were divided into the group with synchronous airway lesions(SALs group)(n=40)and the group without SALs(n=36),the group with neuromuscular dysplasia(NMD group)(n=35)and the group without NMD(n=41),the group with congenital heart disease(CHD group)(n=40)and the group without CHD(n=36),the group with congenital syndromes(CS group)(n=23),and the group without CS(n=53).The clinical characteristics of each group were analyzed retrospectively,and the improvement of symp-toms after discharge and the postoperative outcome of severe ILM were followed up.Results:Compared with the severe group,the proportion of typeⅡILM in the mild-moderate group was higher(P<0.05).The improvement rate of failure to thrive(FTT)in the severe group was lower than that in the mild-moderate group half a year after discharge(13.8%vs 53.3%,P<0.05),but the difference was not statistically significant one year after discharge(P>0.05).The improvement rate of FTT in the group with NMD at one year after discharge was lower than that in the group without NMD(32.0%vs 73.7%,P<0.05).Among the children with severe ILM,a total of 12 cases had surgery by bronchoscopy,including 6 cases of supraglottoplasty surgery,and 6 cases of laryngopha-ryngeal/epiglottic mass/cyst resection and the clinical symptoms of postoperative patients from two different surgical approaches were alleviated.Conclusion:Combined NMD has a great impact on the growth and development of ILM children,early and timely intervention of severe ILM can improve clinical symptoms earlier and the choices of surgical approaches should be individualized.