Uroz-Tristán J, Sanchís Solera L, Benítez del Rosario J, Martínes Sopena J, Alonso Jiménez L, López-Pinto J, García Urgellés X
Servicio de Cirugía Pediátrica, Hospital Materno Infantil, Las Palmas de Gran Canaria.
Cir Pediatr. 1995 Apr;8(2):68-71.
Acquired or congenital laryngotracheal stenosis is uncommon in children although premature infants with respiratory distress syndrome (SDR) requiring ventilatory support with prolonged intubation are at great risk. The different treatments used in the past show high rates of morbidity and mortality. Following the technique described by Cotton in 1980, anterior cricoid slit procedure in the upper two tracheal rings has been used as a primary treatment on five patients since 1991, four by intrinsic stenosis and one by extrinsic. Extubation failed in four of them, checking trough bronchoscopy different grades of laryngotracheal stenosis and in the fifth due to respiratory distress, secondary to subcricoid stenosis. Anterior cricoid split procedure with intubation with conventional endotracheal tube (SET) or Montgomery tube (TTM) was performed on infants whose ages ranged from 4 to 18 months old (averaged 8 months). They were extubated between the 5th and 340th days after surgery. Two of them underwent complications: a skin-tracheal fistula and a paresis of the left vocal cord, the two are asymptomatic after four and eighteen months of the procedure. All patients discharged without signs of upper airway obstruction, except one who developed a granuloma which diminished with cortisone. Anterior cricoid split with prolonged intubation is a safe and useful technique for the treatment of laryngotracheal stenosis.
获得性或先天性喉气管狭窄在儿童中并不常见，尽管患有呼吸窘迫综合征（RDS）且需要长时间插管通气支持的早产儿面临很大风险。过去使用的不同治疗方法显示出高发病率和死亡率。自1991年以来，按照1980年科顿描述的技术，对上两个气管环进行前环状软骨切开术已被用作5例患者的主要治疗方法，其中4例为先天性狭窄，1例为后天性狭窄。其中4例拔管失败，通过支气管镜检查发现不同程度的喉气管狭窄，第5例因环状软骨下狭窄继发呼吸窘迫而拔管失败。对年龄在4至18个月（平均8个月）的婴儿进行前环状软骨切开术并插入传统气管内导管（SET）或蒙哥马利管（TTM）。他们在术后第5天至第340天之间拔管。其中2例出现并发症：皮肤气管瘘和左侧声带麻痹，在手术后4个月和18个月这两种并发症均无症状。除1例出现肉芽肿经皮质激素治疗后减轻外，所有患者出院时均无气道梗阻迹象。前环状软骨切开术加延长插管是治疗喉气管狭窄的一种安全有效的技术。
