Senders C W, Navarrete E G
Department of Otolaryngology - Head and Neck Surgery, University of California, Davis, Suite 7200, 2521 Stockton Boulevard, Sacramento, CA 95817, USA.
Int J Pediatr Otorhinolaryngol. 2001 Mar;57(3):235-44. doi: 10.1016/s0165-5876(00)00461-4.
To evaluate different CO2 laser procedures on children with various types of laryngomalacia and determine the role of associated anomalies on the outcome.
Retrospective chart review.
Academic tertiary referral center.
Twenty-three children who underwent laser supraglottoplasty for laryngomalacia between 1991 and 1998 at the UC Davis Medical Center.
CO2 laser vaporization of redundant supraglottic mucosa of the aryepiglottic fold, arytenoid, and the epiglottis, or modification of the latter, either individually or in combination, based on the obstructing anatomy.
Immediate, short term, intermediate and long term relief of respiratory symptoms, feeding difficulties, effect of associated anomalies on outcome, effect of specific anatomic obstructing site and surgical procedure performed on outcome, and the incidence of complications inherent to the procedure.
Children without associated anomalies invariably did very well, with 78% immediately resolving their respiratory symptoms and 100% within a week. Twelve of the 14 patients with unfavorable immediate results (P<0.01) and all ten with short term unfavorable results (P<0.05) had neurologic or anatomic associated anomalies. Seven patients, all with associated anomalies, were considered surgical failures (P<0.05). These patients also had a significantly longer hospital stay (P<0.01). The presence of associated anomalies was significant (P<0.01) in determining surgical treatment of reflux or the need for an NG tube in treating feeding problems. The anatomic site of abnormality and the specific procedure performed did not affect the outcome. There were no serious complications inherent to this procedure.
Laser supraglottoplasty, in its different modalities, is a safe and effective treatment for all types of laryngomalacia, but children with associated neurologic or anatomic anomalies will have a more complicated immediate and short term course, as well as a significant incidence of failure. Gastroesophageal reflux is an important associated condition that requires investigation in these patients, and in severe cases will merit surgical procedures to manage. The high incidence of associated neuromuscular anomalies suggests that this component has an important role in the etiology of laryngomalacia.
评估不同的二氧化碳激光手术对不同类型喉软化症患儿的疗效，并确定相关异常对手术结果的影响。
回顾性病历审查。
学术性三级转诊中心。
1991年至1998年期间在加州大学戴维斯分校医疗中心接受激光声门上成形术治疗喉软化症的23名儿童。
根据阻塞性解剖结构，单独或联合使用二氧化碳激光汽化杓会厌襞、杓状软骨和声门上多余的黏膜，或对声门进行修整。
呼吸症状、喂养困难的即刻、短期、中期和长期缓解情况，相关异常对手术结果的影响，特定解剖阻塞部位和所施行手术对手术结果的影响，以及该手术固有的并发症发生率。
无相关异常的患儿手术效果始终良好，78%的患儿呼吸症状即刻缓解，100%在一周内缓解。14例即刻效果不佳的患儿中有12例（P<0.01），所有10例短期效果不佳的患儿（P<0.05）均有神经或解剖学相关异常。7例均有相关异常的患儿被视为手术失败（P<0.05）。这些患儿的住院时间也显著更长（P<0.01）。相关异常在确定反流的手术治疗或治疗喂养问题时鼻胃管的需求方面具有显著意义（P<0.01）。异常的解剖部位和所施行的具体手术并未影响手术结果。该手术没有固有的严重并发症。
不同方式的激光声门上成形术是治疗所有类型喉软化症的一种安全有效的方法，但伴有神经或解剖学异常的患儿在即刻和短期内病程会更复杂，且失败率较高。胃食管反流是一种重要的相关疾病，在这些患儿中需要进行检查，严重时值得进行手术治疗。相关神经肌肉异常的高发生率表明该因素在喉软化症的病因中起重要作用。
