Huo H, Li W Y, Wang J, Yang D H, Liu J H, Jin X F, Niu Y Y
Department of Otorhinolaryngology, Peking Union Medical College Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, 100730, China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2017 Nov 20;31(22):1716-1719. doi: 10.13201/j.issn.1001-1781.2017.22.002.
Pharyngeal stenosis as a postoperative complication following pharyngeal surgery (tonsillectomy/adenoidectomy) with coblation is rare and may be difficult to treat. This report is to explore the causes of pharyngeal stenosis and presents our successful treatment experience. From Jan 2012 to July 2016, 5 children with pharyngeal stenosis (2 nasopharyngeal stenosis and 3 nasopharyngeal stenosis combined with oropharyngeal stenosis) secondary to pharyngeal surgery (tonsillectomy/adenoidectomy) in Peking Union Medical College Hospital were analyzed. Five cases with severe nasopharyngeal stenosis received surgery of scar resection, horizontal-to-vertical pharyngoplasty and local pharyngeal flap rotation; and three of them received free skin transplantation. After stenosis repair surgery, prolonged nasopharyngeal hollow stents were used for more than 6 months. To evaluate the therapeutic effect, pharyngeal cavities and symptoms of difficulty nasal breathing, mouth breathing, difficulty in blowing nose, hyponasal speech, snoring, restless sleep, anosmia, dysphagia were assessed and compared before and after surgery. With 7-46 months follow-up, all symptoms of the 5 cases are ameliorated and the diameters of nasopharyx are more than 1.5 cm. No velopharyngeal insufficiency complication happened. Improper operation with coblation can cause severe pharyngeal stenosis. Flap rotation, horizontal-to-vertical pharyngoplasty and prolonged use nasopharyngeal hollow stents are reliable methods to correct pharyngeal stenosis following children's pharyngeal surgery.
作为使用低温等离子消融术进行咽手术（扁桃体切除术/腺样体切除术）后的一种术后并发症，咽狭窄很罕见且可能难以治疗。本报告旨在探讨咽狭窄的病因并介绍我们成功的治疗经验。分析了2012年1月至2016年7月在北京协和医院接受咽手术（扁桃体切除术/腺样体切除术）继发咽狭窄的5例患儿（2例为鼻咽狭窄，3例为鼻咽狭窄合并口咽狭窄）。5例严重鼻咽狭窄患者接受了瘢痕切除术、水平-垂直咽成形术和局部咽瓣旋转术；其中3例接受了游离皮肤移植。狭窄修复手术后，使用延长的鼻咽空心支架超过6个月。为评估治疗效果，对手术前后的咽腔以及鼻呼吸困难、口呼吸、擤鼻困难、鼻音减退、打鼾、睡眠不安、嗅觉减退、吞咽困难等症状进行了评估和比较。经过7至46个月的随访，5例患者的所有症状均得到改善，鼻咽直径超过1.5厘米。未发生腭咽闭合不全并发症。低温等离子消融术操作不当可导致严重的咽狭窄。瓣旋转、水平-垂直咽成形术和延长使用鼻咽空心支架是纠正儿童咽手术后咽狭窄的可靠方法。
