Jiménez Isabel M A, Matute Cárdenas J A, Delgado Muñoz M D, Aguado Roncero P, Villafruela M A, Berchi F J
Servicio de Cirugía Pediátrica, Hospital 12 de Octubre, Madrid.
Cir Pediatr. 1997 Jan;10(1):38-41.
Incidence of pediatric laryngeal stenosis has increased due to better Intensive Care Units. The medical records of the patients with laryngeal stenosis treated in the hospital between 1990 and 1995 were reviewed, analyzing the type of lesion, ethiologic factors, surgical technique employed and post-op result. The surgical technique was chosen conditioned by the age, weight of the patient, grade of the stenosis according to Cotton's classification and presence or absence of respiratory distress. 48 patients had laryngeal stenosis. 2 of them had acute glottic edema (4%) and 45 subglottic stenosis (96%), most of them after long term endotracheal intubation, 34 cases (75.5%). 19 of these occurred in the neonatal period. 7 cases (15.5%) were congenital stenosis (2 subglottic membranes, 1 subglottic cyst and 4 true congenital subglottic stenosis). 5 cases were a miscelanea. We found 13 grade I cases (29%), grade II 16 cases (35%) and grade III 12 (27%). No grade IV were seen. 8 patients (18%) had gastro-esophageal reflux, 5 of them required Nissen's funduplication before airway surgery. 12 patients followed medical treatment (27%), all of them grades I and II, with good results. Endoscopic treatment was done in 6 patients (13%), with good results in all but one that required a surgical approach. The anterior cricothiroid split was done in 7 patients (15%), all of them under 5 months of age. Good results were obtained in 71.4 percent of the patients. 9 cases (20%) underwent an anterior largingotracheoplasty with costal cartilage graft with good results in 88.9 percent of the patients. Anterior and posterior cartilage graft after double laringotracheoplasty was done to 8 patients (18%). One of them developed a subglottic sinequiae which was solved endoscopically, and another patient evolved to restenosis. 20 patients had a tracheostomy. All but four were decanulated in 11.7 +/- 12.3 (4-54) weeks. Mortality rate associated with the surgical technique has been zero, with excellent results in 82.5 percent of the series. The new surgical techniques developed in recent years for laringotracheal stenosis in childhood have made unnecessary the use of permanent tracheostomies in these children which have obvious inconvenient and potentially lethal complications.
由于重症监护病房条件的改善，小儿喉狭窄的发病率有所上升。回顾了1990年至1995年在该医院接受治疗的喉狭窄患者的病历，分析了病变类型、病因、所采用的手术技术及术后结果。手术技术的选择取决于患者的年龄、体重、根据科顿分类法的狭窄程度以及是否存在呼吸窘迫。48例患者患有喉狭窄。其中2例为急性声门水肿（4%），45例为声门下狭窄（96%），大多数患者是在长期气管插管后发生的，共34例（75.5%）。其中19例发生在新生儿期。7例（15.5%）为先天性狭窄（2例声门下膜、1例声门下囊肿和4例真正的先天性声门下狭窄）。5例为其他情况。我们发现13例I级病例（29%），II级16例（35%），III级12例（27%）。未见IV级病例。8例患者（18%）有胃食管反流，其中5例在气道手术前需要进行尼森胃底折叠术。12例患者接受内科治疗（27%），均为I级和II级，效果良好。6例患者（13%）接受了内镜治疗，除1例需要手术治疗外，其余效果均良好。7例患者（15%）进行了环甲膜前裂开术，均为5个月以下婴儿。71.4%的患者取得了良好效果。9例患者（20%）接受了带肋软骨移植的前喉气管扩大成形术，88.9%的患者效果良好。8例患者（18%）在双重喉气管成形术后进行了前后软骨移植。其中1例出现声门下粘连，经内镜解决，另1例发展为再狭窄。20例患者进行了气管切开术。除4例患者外，其余患者在11.7±12.3（4 - 54）周内拔管。与手术技术相关的死亡率为零，该系列中82.5%的患者效果极佳。近年来为儿童喉气管狭窄开发的新手术技术使得这些儿童无需进行永久性气管切开术，而永久性气管切开术有明显不便且存在潜在致命并发症。
