Maeda Kosaku, Ono Shigeru, Baba Katsuhisa
Division of Pediatric Surgery, Department of Surgery, Jichi Medical University School of Medicine, 3311-1, Yakushiji, Shimotsuke, Tochigi, 329-0498, Japan,
Pediatr Surg Int. 2013 Oct;29(10):1001-6. doi: 10.1007/s00383-013-3397-2.
Although many advances have improved the treatment of congenital and acquired laryngotracheal stenosis in children over the past two decades, the therapeutic decision-making process remains challenging for pediatric surgeons and otolaryngologists. Severe subglottic stenosis is a complex laryngeal injury that necessitates multiple airway procedures, and the approach depends on the exact nature of the cicatricial lesion and its effect on the vocal cord mobility. Therefore, it is imperative that the pediatric surgeons and otolaryngologists dealing with this situation should be well trained in endoscopy and laser treatment, in addition to open surgical intervention. Open re-do surgery remains the best choice in cases of severe congenital stenosis, glottic immobility, or after two to three endoscopic procedures have been performed without any significant improvement.
尽管在过去二十年中取得了许多进展,改善了儿童先天性和后天性喉气管狭窄的治疗,但对于小儿外科医生和耳鼻喉科医生来说,治疗决策过程仍然具有挑战性。严重的声门下狭窄是一种复杂的喉部损伤,需要多次气道手术,而手术方法取决于瘢痕性病变的确切性质及其对声带活动的影响。因此,处理这种情况的小儿外科医生和耳鼻喉科医生除了进行开放手术干预外,还必须在内镜检查和激光治疗方面接受良好的培训。对于严重先天性狭窄、声门固定或在进行两到三次内镜手术后没有任何明显改善的病例,开放再次手术仍然是最佳选择。