儿童声门下瘢痕性狭窄呼吸介入治疗效果观察（附23例报告）

Effect of respiratory interventional therapy for subglottic cicatricial stenosis (23 cases)

摘要:

目的 观察儿童声门下瘢痕性狭窄介入治疗的效果，总结治愈成功的经验，探讨儿科呼吸介入技术在儿童声门下瘢痕性狭窄中的应用价值。方法 回顾性分析2017年12月－2020年12月昆明市儿童医院呼吸内科收治的23例声门下瘢痕性狭窄患儿的临床资料。其中，男14例，女9例；年龄28 d～8岁。所有病例均有气管插管史，且在拔管后出现了严重的吸气性呼吸困难症状，通过喉镜或支气管镜确诊后经呼吸介入治疗。以气管切开为预案来保障呼吸通畅。结果 狭窄程度75%～90%的3例，狭窄程度大于90%的20例，所有病例的狭窄长度均小于1 cm。前4例行单纯球囊扩张4次，因疗效不佳改为钬激光、钳夹、球囊扩张和冷冻等综合呼吸介入治疗，最终治愈。后19例则直接应用以上综合呼吸介入技术治疗，均治愈。结论 声门下瘢痕性狭窄的呼吸介入治疗中，应用单纯球囊扩张即时效果好，远期效果欠佳，应用以冷冻为主的多种呼吸介入治疗，治愈率和安全性均较高。

Abstract:

Objective To observe the effect of interventional treatment of children with subglottic cicatricial stenosis, summarize the successful treatment experience, and discuss the application value of pediatric respiratory interventional technology in children with subglottic cicatricial stenosis.Methods The clinical data of 23 children with subglottic cicatricial stenosis from December 2017 to December 2020 were retrospectively analyzed. Among them, there were 14 males and 9 females, aged 28 d ~ 8 years old. All patients had a history of endotracheal intubation and had severe respiratory dyspnea after extubation, which was confirmed by laryngoscopy or bronchoscope and then treated with respiratory intervention. Use tracheotomy as a preplan to ensure patency of breathing.Results In this study, there were 3 cases with stenosis degree of 75% ~ 90%, 20 cases with stenosis degree greater than 90%, and the stenosis length of all cases was less than 1 cm. The previous 4 cases underwent simple balloon dilation for 4 times, but due to poor efficacy, the patients were changed to comprehensive respiratory interventional therapy, such as holmium laser therapy, clamp therapy, balloon dilation therapy, cryotherapy, and finally cured. The last 19 cases were treated with the above comprehensive respiratory intervention techniques directly, and the results were all cured.Conclusion Balloon dilation is effective in the treatment of subglottic cicatricial stenosis caused by tracheal intubation, but the long-term effect is not good. The application of thermal therapy, clip therapy, balloon dilation therapy, cold therapy and other comprehensive interventional therapy, the therapeutic effect is stable, the cure rate is high, the safety is high.