Monnier P, Savary M, Chapuis G
University Hospital CHUV, Lausanne, Switzerland.
Acta Otorhinolaryngol Belg. 1995;49(4):373-82.
Controversy still exists concerning the best treatment modality for severe (Cotton's grade III and IV) subglottic stenosis in infants and children. Although laryngotracheoplasty procedures remain the operation of choice in most centres, this series of 26 partial cricoid resections with primary thyrotracheal anastomoses show a decannulation rate of 96% (25/26 cases) after a single open procedure. Twenty-three patients practice sport freely without dyspnea, 2 show a slight exertional stridor and one teenager experienced a complete restenosis. The postoperative voice is normal in 18 (70%) and a slight residual dysphonia is present in 7 (27%). We encountered no lesion to the recurrent laryngeal nerves and no fatalities. In 10 cases, the tracheostoma site was resected during the same operative session. In the future, cricotracheal resection should be considered as an important, if not the best, treatment option for severe subglottic stenosis in infants and children.
关于婴幼儿重度（科顿III级和IV级）声门下狭窄的最佳治疗方式仍存在争议。尽管在大多数中心，喉气管成形术仍是首选手术，但这组26例次全环状软骨切除术并一期甲状腺气管吻合术的病例显示，单次开放手术后拔管率为96%（25/26例）。23例患者可自由进行体育活动且无呼吸困难，2例有轻微运动性喘鸣，1例青少年出现完全再狭窄。18例（70%）术后嗓音正常，7例（27%）有轻微残余发声障碍。我们未遇到喉返神经损伤，也无死亡病例。10例患者在同一次手术中切除了气管造口部位。未来，环状气管切除术应被视为婴幼儿重度声门下狭窄的一种重要治疗选择，即便不是最佳选择。
