Cotton R T, Evans J N
Ann Otol Rhinol Laryngol. 1981 Sep-Oct;90(5 Pt 1):516-20. doi: 10.1177/000348948109000522.
Congenital and acquired subglottic stenosis is a commonly encountered problem in the pediatric population. In acquired cases endotracheal intubation is responsible for its development in the great majority of cases, but high tracheotomy, laryngeal burns, external neck trauma, and tumors, both intrinsic and extrinsic, are occasionally seen. The management of mature subglottic stenosis in children remains a controversial issue. The prevailing attitude of otolaryngologists is to perform a tracheotomy and hope for decannulation after one or two years, due to the expected growth of the larynx. Unfortunately, some of the acquired lesions are so severe that often no lumen is demonstrable. In such cases no amount of growth will allow extubation. A variety of endoscopic methods, such as dilation with or without resection using diathermy or laser, are certainly helpful in the early phases of wound healing while the scar tissue is soft and pliable. To deal with the mature, hard, fibrous, unresponsive scar various authors have proposed differing laryngotracheal reconstructive techniques. The authors discuss a unique experience of laryngotracheal reconstruction in 103 children. They define their indications for the three procedures that are most widely used, and address the issue raised by opponents of laryngotracheal reconstruction in children, namely the consideration that laryngeal growth potential may be adversely affected by such external operations. The authors have evidence that this has not occurred in 35 cases followed for a minimum of five years.
先天性和后天性声门下狭窄是儿科人群中常见的问题。在后天性病例中，绝大多数情况下气管插管是其发生的原因，但高位气管切开、喉部烧伤、颈部外伤以及内在和外在肿瘤也偶尔可见。儿童成熟声门下狭窄的治疗仍然是一个有争议的问题。耳鼻喉科医生的普遍态度是进行气管切开，并希望在一两年后因喉部预期生长而拔管。不幸的是，一些后天性病变非常严重，往往没有可显示的管腔。在这种情况下，无论喉部如何生长都无法拔管。各种内镜方法，如使用透热疗法或激光进行扩张或切除，在伤口愈合的早期阶段，当瘢痕组织柔软且有柔韧性时肯定是有帮助的。为了处理成熟、坚硬、纤维化且无反应的瘢痕，不同的作者提出了不同的喉气管重建技术。作者讨论了103例儿童喉气管重建的独特经验。他们明确了最广泛使用的三种手术的适应证，并回应了儿童喉气管重建反对者提出的问题，即担心这种外部手术可能会对喉部生长潜力产生不利影响。作者有证据表明，在至少随访五年的35例病例中并未出现这种情况。
