Duan Xiaojun,Huang Jianbao,Wang Jiangping,et al.Interventional treatment of acquired subglottic stenosis in children by fiberoptic bronchoscopy[J].Journal of Clinical Pediatric Surgery,2020,19(07):631-635.[doi:10.3969/j.issn.1671-6353.2020.07.014]
经纤维支气管镜介入治疗儿童获得性声门下狭窄
- Title:
- Interventional treatment of acquired subglottic stenosis in children by fiberoptic bronchoscopy
- Keywords:
- Bronchoscopy; Glottis/SU; Glottis/IN; Child
- 分类号:
- R616.5
- 摘要:
- 目的 探讨儿童获得性声门下狭窄经纤维支气管镜的介入治疗方法及其有效性。方法 回顾性分析2019年1月至2019年11月湖南省儿童医院收治的12例获得性声门下狭窄患儿临床资料；男9例，女3例；年龄26天至3岁11个月。参考Freitag的中心气道狭窄分类标准对入组患儿声门下狭窄进行形态学分类，根据患儿的Freitag形态学分类特点选择纤维支气管镜介入治疗方法。结果 12例中11例达到临床治愈，有效率达91.67%，其中7例长度<1 cm的声门下短段瘢痕性狭窄患儿单用球囊扩张即可达到治疗效果，2例声门下狭窄段长度超过1 cm的患儿和2例气管内肉芽组织增生患儿需要多种介入方法联合治疗。1例合并先天性心脏病和猫叫综合征的患儿介入治疗无效，不能撤离呼吸机。结论 经纤维支气管镜介入治疗儿童获得性声门下狭窄有效。Freitag的中心气道狭窄分类标准可用于指导医生选择儿童获得性声门下狭窄的介入治疗方法和评估预后。对于声门下短段瘢痕性狭窄（<1 cm）患儿，推荐单用球囊扩张治疗，以减少手术时间，并缩短疗程。
- Abstract:
- Objective To explore the interventional therapy and effectiveness of fiberoptic bronchoscopy for children with acquired subglottic stenosis.Methods From January 2019 to November 2019,retrospective analysis was performed for clinical data of 12 hospitalized children with acquired subglottic stenosis.There were 9 boys and 3 girls with a median age of 10.8 months (26 days to 47 months).According to the Freitag’s classification standard of central airway stenosis,the morphological classification of subglottic stenosis was implemented.Different interventions were selected based upon the characteristics of Freitag’s morphological classification.Results Eleven cases were cured clinically with an effective rate of 91.67%.And 7 cases with a length of <1cm underwent balloon dilation alone.Two children with subglottic stenosis >1 cm in length and two cases of endotracheal granulomatosis received multiple interventions.One child with congenital heart disease and Cri-du-chat syndrome had no response to interventional therapy and could not be weaned off from a ventilator.Conclusion Interventional treatment is both safe and effective for acquired subglottic stenosis in children.Freitag’s criteria for classifying central airway stenosis may be employed to guide the choice of interventional therapy and evaluate the prognosis of children with acquired subglottic stenosis.For short scarred subglottic stenosis (<1 cm),balloon dilation alone is recommended due to a shorter operative duration and simpler treatment sequence.
参考文献/References:
1 Marston AP,White DR.Subglottic Stenosis[J].Clin Perinatol,2018,45(4):787-804.DOI:10.1016/j.clp.2018.07.013.
2 Soong WJ.Pediatric interventional flexible bronchoscopy[J].Pediatr Respirol Crit Care Med,2018,2:38-44.DOI:10.4103/prcm.prcm_12_18.
3 Jiao A,Liu F,Lerner AD,et al.Effective treatment of post-intubation subglottic stenosis in children with holmium laser therapy and cryotherapy via flexible bronchoscopy[J].Pediatr Invest,2019,3(1):9-16.DOI:10.1002/ped4.12113.
4 Freitag L,Ernst A,Unger M,et al.A proposed classification system of central airway stenosis[J].Eur Respir J,2007,30(1):7-12.DOI:10.1183/09031936.00132804.
5 Lyons M,Vlastarakos PV,Nikolopoulos TP.Congenital and acquired develop-mental problems of the upper airway in newborns and infants[J].Early Hum Dev,2012,88(12):951-955.DOI:10.1016/j.earlhumdev.2012.09.001.
6 Durden F,Sobol SE.Balloon laryngoplasty as a primary treatment for subglottic stenosis[J].Arch Otolaryngol Head Neck Surg,2007,133(8):772-775.DOI:10.1001/archotol.133.8.772.
7 de Alarcon A,Rutter MJ.Cervical slide tracheoplasty[J].Arch Otolaryngol Head Neck Surg,2012,138(9):812-816.DOI:10.1001/archoto.2012.1768.
8 Jefferson ND,Cohen AP,Rutter MJ,et al.Subglottic stenosis[J].Semin Pediatr Surg,2016,25(3):138-143.DOI:10.1053/j.sempedsurg.2016.02.006.
9 刘霞,张忠晓,赵凤美,等.支气管镜下综合介入治疗儿童插管后声门部及声门下狭窄28例[J].中华实用儿科临床杂志,2015,30(16):1245-1248.DOI:10.3760/cma.j.issn.2095-428X.2015.16.014. Liu X,Zhang ZX,Zhao FM,et al.Comprehensive Interventional Bronchoscopy for glottis and subglottic stenosis after intubation: a report of 28 children[J].Chin J Appl Clin Pediatr,2015,30(16):1245-1248.DOI:10.3760/cma.j..issn.2095-428X.2015.16.014.
10 黄伟坚,李永乐,陈佩玲,等.保留自主呼吸喉罩全麻在婴儿声门下狭窄钬激光消融术中的应用[J].临床小儿外科杂志,2019,18(4):319-322.DOI:10.3969/j.issn.1004-647X.2018.19.118. Huang WJ,Li YL,Chen PL,et al.Application of laryngeal mask airway with spontaneous breathing under general anesthesia during holmium laser ablation for infantile subglottic stenosis[J].J Clin Ped Sur,2019,18(4):319-322.DOI:10.3969/j.issn.1004-647X.2018.19.118.
11 Avelino M,Maunsell R,Jube Wastowski I.Predicting outcomes of balloon laryngoplasty in children with subglottic stenosis[J].Int J Pediatr Otorhinolaryngol,2015,79(4):532-536.DOI:10.1016/j.ijporl.2015.01.022.
12 Cuestas G,Rodríguez V,Doormann F,et al.Endoscopic treatment of acquired subglottic stenosis in children: Predictors of success[J].Arch Argent Pediatr,2018,116(6):422-425.DOI:10.5546/aap.2018.eng.422.
13 Lang M,Brietzke SE.A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis[J].Otolaryngol Head Neck Surg,2014,150(2):174-179.DOI:10.1177/0194599813510867.
14 穆德广,陈敏,薄丽艳,等.支气管镜介入技术治疗气管插管、气管切开后中心气道狭窄的前瞻性随机对照研究[J].国际呼吸杂志,2019,39(3):220-224.DOI:10.3760/cma.j.issn.1673-436X.2019.03.012. Mu DG,Chen M,Bo LY,et al.A comparative study of interventional bronchoscopy for central airway stenosis after tracheal intubation and tracheotomy[J].Int J respir,2019,39(3):220-224.DOI:10.3760/cma.j.issn.1673-436X.2019.03.012.
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备注/Memo
收稿日期:2019-12-28。
基金项目:湖南省科技厅临床医疗创新引导项目（编号：2018SK50406）
通讯作者:陈艳萍,Email:hnchengyanping@163.com