Thomé R, Thomé D C
Private Clinic of Head and Neck Surgery, São Paulo, Brazil.
Arch Otolaryngol Head Neck Surg. 1998 Jun;124(6):660-4. doi: 10.1001/archotol.124.6.660.
To determine the results of posterior cricoidotomy lumen augmentation in the treatment of moderate and severe subglottic stenosis in children, and to assess the effect of this surgery on the growth of the larynx in young children.
A 17-year retrospective study.
Thirteen children with moderate and severe subglottic stenosis who underwent posterior cricoidotomy lumen augmentation from 1980 to 1996. Eight children (62%) were male and 5 (38%) were female. The average age was 4.7 years (age range, 8 months to 15 years). Six (46%) of the 13 children were younger than 3 years. Nine children (69%) had acquired subglottic stenosis, 3 of whom had a combined subglottic-posterior glottic stenosis, and 4 (31%) had congenital subglottic stenosis. All the children already had a tracheotomy tube placed and had undergone treatment at our clinic or at other institutions. The surgical procedure we used included a cricoid lamina split with grafting (2 children with costal cartilage graft and 11 with buccal mucosal graft) and stenting.
Twelve (92%) of the 13 children underwent decannulation, and 1 (8%) is still undergoing treatment: decannulation is expected to be carried out in the near future. Of the 12 children who underwent decannulation, 9 demonstrated good postoperative voice quality and 3, who had combined subglottic-posterior glottic stenosis, developed impaired voice function. Following stent removal, all children experienced some degree of difficulty in swallowing saliva and liquids, which was soon overcome. No evidence of surgery-induced laryngeal growth impairment in younger children was observed.
The posterior cricoidotomy lumen augmentation is a safe and effective technique for the treatment of moderate and severe subglottic stenosis in children of any age. This study lends further support to the assertion that external surgery does not affect the growth of the larynx in younger children.
确定后环状软骨切开术扩大管腔治疗儿童中重度声门下狭窄的效果，并评估该手术对幼儿喉部生长的影响。
一项为期17年的回顾性研究。
1980年至1996年间接受后环状软骨切开术扩大管腔的13例中重度声门下狭窄患儿。8例（62%）为男性，5例（38%）为女性。平均年龄4.7岁（年龄范围8个月至15岁）。13例患儿中有6例（46%）年龄小于3岁。9例（69%）患儿为后天性声门下狭窄，其中3例合并声门下-后声门狭窄，4例（31%）为先天性声门下狭窄。所有患儿均已行气管切开置管，并在我院或其他机构接受过治疗。我们采用的手术方法包括环状软骨板劈开并移植（2例采用肋软骨移植，11例采用颊黏膜移植）及置入支架。
13例患儿中有12例（92%）拔管，1例（8%）仍在接受治疗，预计近期可拔管。在12例拔管患儿中，9例术后嗓音质量良好，3例合并声门下-后声门狭窄的患儿出现嗓音功能受损。支架取出后，所有患儿均出现一定程度的吞咽唾液和液体困难，但很快得到克服。未观察到手术导致年幼儿童喉部生长受损的证据。
后环状软骨切开术扩大管腔是治疗各年龄段儿童中重度声门下狭窄的一种安全有效的技术。本研究进一步支持了外部手术不影响年幼儿童喉部生长这一观点。
