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[小儿喉气管狭窄]

[Paediatric laryngotracheal stenosis].

作者信息

Sittel C

机构信息

Klinik für Hals-, Nasen-, Ohrenkrankheiten, Plastische Operationen, Klinikum Stuttgart, Stuttgart, Germany.

出版信息

Laryngorhinootologie. 2012 Aug;91(8):478-85. doi: 10.1055/s-0032-1312629. Epub 2012 Jun 14.

Abstract

Laryngotracheal stenosis in infancy and childhood is challenging in many aspects. Diagnosis and therapy require specific expertise and must be tailored to the individual case. The most important presentations of airway pathology in children are presented in this paper. Conservative, endoscopic and surgical treatment options are discussed. Laryngomalazia is the most frequent condition of supraglottic stenosis. The term supraglottoplasty summarizes all different techniques used for it's repair using an endoscopic approach.Glottic stenosis is rare in children. Usually a compromise between voice preservation and airway restoration has to be sought. Type of reconstruction and timing are varying considerably in individual cases, endoscopic approaches should be preferred.Subglottic stenosis remains the largest group in paediatric airway pathology, with cicatrial stenosis being predominant. Today, cricotracheal resection is the most successful treatment option, followed by the classical laryngotracheal reconstruction with autologous cartilage. In early infancy subglottic stenosis is particularly demanding. Endoscopic treatment is possible in selected patients, but open reconstruction is superior in more severe cases. Subglottic stenosis in children requires expertise and experience in diagnosis and treatment. Considering the limited incidence these cases should be managed in a referral center.

摘要

婴幼儿及儿童喉气管狭窄在很多方面都具有挑战性。诊断和治疗需要特定的专业知识,且必须根据具体病例进行调整。本文介绍了儿童气道病变的最重要表现形式。讨论了保守、内镜及手术治疗方案。喉软化是声门上狭窄最常见的情况。声门上成形术概括了使用内镜方法对其进行修复的所有不同技术。声门狭窄在儿童中较为罕见。通常必须在保留嗓音和恢复气道之间寻求平衡。重建类型和时机在不同病例中差异很大,应优先选择内镜方法。小儿气道病变中,声门下狭窄仍是最大的一组,瘢痕性狭窄最为常见。如今,环状气管切除术是最成功的治疗选择,其次是经典的自体软骨喉气管重建术。在婴儿早期,声门下狭窄的治疗要求特别高。部分患者可行内镜治疗,但在病情更严重的病例中,开放重建术更具优势。儿童声门下狭窄的诊断和治疗需要专业知识和经验。鉴于发病率有限,这些病例应在转诊中心进行管理。

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