婴幼儿先天性喉软化症的诊疗新进展

New progress in diagnosis and treatment of congenital laryngomalacia in infants

先天性喉软化症是引起婴幼儿喉喘鸣最常见的原因,其发病机制尚无明确结论,可能与喉部软骨解剖结构发育异常、神经肌肉功能紊乱、胃食管及咽喉反流疾病等有关。典型表现为吸气性喉喘鸣、喂养困难,根据症状严重程度可分为轻、中、重度。主要结合临床症状、体征和内镜检查进行诊断,其中内镜检查是重要的诊断依据。喉软化症的治疗取决于症状的严重程度,轻度及部分中度患儿可经保守治疗自行缓解,部分中度及重度患儿应行手术治疗,声门上成形术是主要的手术方式,可有效地改善绝大多数先天性喉软化患儿喉喘鸣、吸气性呼吸困难、喂养困难、发育迟缓等症状,手术效果良好。

Congenital laryngomalacia is the most common disease causing laryngeal stridor in infants.The pathogenesis has not yet been clearly concluded.It may be related to abnormal development of laryngeal cartilage anatomical structure,neuromuscular dysfunction,gastroesophageal and laryngeal reflux disease,etc.The typical manifestations of the disease are inspiratory laryngeal stridor and feeding difficulties,which can be divided into mild,moderate and severe according to the severity of symptoms.The diagnosis is mainly based on clinical symptoms,signs and endoscopy,among which endoscopy is an important diagnostic basis.The treatment of laryngomalacia depends on the severity of symptoms.Mild and some moderate congenital laryngomalacia children can be relieved by conservative treatment,and severe and some moderate congenital laryngomalacia children should be treated by surgery.Supraglottic plasty is the main surgical method,which can effectively improve the symptoms of laryngeal stridor,dyspnea,feeding difficulties and growth retardation in most children,and the surgical effect is good.