儿童喉气道疾病的诊治与展望

Diagnosis and treatment of disorders of laryngeal airway in children and prospect

此文章主要是描述对儿童喉气道疾病的诊断和治疗,其疾病包括先天性结构异常、感染及肿瘤,提供了一些新的诊治技术。根据儿童疾病的特点,阐述了儿童上气道阻塞的临床评估,以及综合性评估包括临床症状学、内镜及影像学检查。其中内镜检查可诊断儿童气道阻塞的程度,也可判断什么性质的疾病。例如喉裂患儿,初次到门诊就诊,可做纤维喉镜检查,得到初步的结果,如果要进一步明确喉裂的程度,需在全身麻醉下做气管硬镜检查,可明确诊断喉裂为Ⅰ型、Ⅱ型、Ⅲa型、Ⅲb型、Ⅳa型及Ⅳb型。对于儿童喉气道疾病的治疗,阐述的主要是两种方法:非手术治疗和手术治疗。举例喉裂患儿,Ⅰ型和部分Ⅱ型喉裂可保守治疗主要是饮食控制,以及进食时体位,手术治疗主要是在内镜下行Ⅱ型和Ⅲ型喉裂修补术。最后展望了一些新技术在诊断和治疗儿童喉气道疾病的应用。

This paper focuses on the diagnosis and treatment of disorders of laryngeal airway in children,including congenital anomalies,infection,and tumor of the larynx to provide a new technology for managing these diseases.Based on the characteristic of them,the pediatric upper airway is dedicated to the clinical evaluation of airway obstruction and the assessment of the compromised pediatric airway,including clinical evaluation of symptoms,diagnostic endoscopy,and imaging examination.Information on endoscopic techniques used for dealing with different degrees of pediatric airway comprised is provided,also this techniques could diagnose what kinds of airway disorder.For example,determining the a particular laryngeal cleft at the initial otolaryngology encounter,flexible laryngoscopy should be performed.In order to define the extent of any identified cleft,the rigid bronchoscopy should be completed to evaluate for classification of laryngeal cleft including typeⅠ,Ⅱ,Ⅲa,Ⅲb,Ⅳa,Ⅳb under general anesthesia.The decision to pursue any therapy for the disorders of laryngeal airway in children should be based on the severity of the patient's symptoms,endoscopic and imaging examination.There are two medical treatments including nonsurgical therapy and surgical therapy.For example the laryngeal cleft,approximately half of type 1 and select type 2 patients can be managed entirely with nonsurgical therapy.Medical management is multifaceted.Under recommendations from the feeding team,a modified diet with thickened feeds and possibly altered feeding position should be initiated.Endoscopic surgical repair is the current gold standard for definitive repair of type 1,the majority of type 2,and selected type 3 clefts.Finally,information on new techniques used into the future for dealing with the diagnosis and treatment of disorders of laryngeal airway in children in this paper.