儿童喉气管狭窄的病因分析及治疗方法的选择

The cause and surgical treatment of laryngotrachealstenosis in children

目的:为提高儿童喉气管狭窄、闭锁的治疗效果,总结了不同部位和范围的狭窄、闭锁患儿的手术方法。方法:共分析了58例儿童喉气管狭窄,年龄15个月-15岁,最多见病因是气管切开术后,其次有喉气管外伤;复发性喉乳头状瘤术后;气管内插管等。全部病例依靠气管切开通道呼吸。根据喉气管狭窄的范围和程度,采用了不同的喉气管重建术。结果:58例中53例(91.4%)经1-5次手术后治愈,拔除气管套管,恢复正常的呼吸功能,随访1-10年,手术效果巩固,儿童发育正常。结论:正确的掌握气管切开技术可以减少儿童喉气管狭窄的发病率。由于儿童喉气管狭窄病情更加复杂多变,术中应根据病变的范围和程度选择适当的手术方法,方能获得满意效果,重建喉气管支架和消除粘膜创面是提高疗效的关键。

Objective: To evaluate the surgical treatment results of laryngotracheal stenosis in children. Methods:The experience of surgical treatment on 28 children's laryngotracheal stenosis was reported. There were 35 males and 23 females,ranging in age from 15 mouths to 15 years old. The tracheotomy, laryngotracheal trauma, recurrent laryngeal papilloma and endotracheal intubation trauma were main cause of laryngotracheal stenosis. All patients were tracheotomized. Various laryngotracheal reconstruction methods were used for these patients depending on the pathologic changes in larynx and trachea. Results:Fifty three patients (91.4%)had been treated successfully with good airway patency and were followed-up for 1 to 10 years. The effect of operation is steady and the growth and development of children is normal. Conclusion:Our finding indicated that skilled tracheotomy is a key to prevent laryngotracheal stenosis in children. The children's laryngotracheal stenosis is more complicated and variable than adult's one and the choice of surgical procedure could be individulized to the pathologic condition of larynx and trachea. Repairing of the mucosa defect and reconstructing a wide enough airway are the technique to improve the curative effect.