支气管镜下钬激光消融术治疗婴幼儿声门下狭窄的临床研究
1400临床肺科杂志2017年8月第22卷第8期
支气管镜下钬激光消融术治疗婴幼儿声门下狭窄的临床研究黄冬平黄苑铭黎静鲁灵龙李敏敏唐远平彭淑梅陈运彬
【摘要】目的探讨支气管镜下钬激光消融术治疗婴幼儿气道狭窄的临床疗效及安全性。方法选取 气道狭窄的患儿10例，其中气管插管后气管瘢痕引起气管重度狭窄6例;先天性气管蹼4例。分别于术前和
术后评估临床症状、支气管镜下病变部位情况、血气分析以及胸部CT的改变。结果10例患儿接受激光治
疗手术后，效果显著8例:气道内狭窄完全解除,腔内的病灶完全清除，临床症状完全改善。有效2例:超过或
等于50%的狭窄管腔解除,腔内的病灶部分清除，通气功能部分恢复功能，临床症状安静时基本改善，胸部
CT的气道狭窄处和肺不张范围较前缩小2/3 -1/2。总体有效率达100%。治疗术中和术后无出现严重并发
症,经随访1年均未见复发。结论支气管镜下钬激光消融术治疗婴幼儿声门下狭窄安全、有效，在临床上值
得进一步观察研究。
【关键词】气道狭窄;激光消融;支气管镜
Clinical study of holmium laser ablation in treatment of infants and young children under bronchoscope HUANG D ong-ping，HUANG Yuan-m ing，L I J in g，LU Ling-long，L I M in-m in，TANG Yuan-
ping，PENG Shu-m ei，CHENYuu-Pin. Guangdong Maternal ang Child Health Hospital，Guangzhoo，Guangdong
510010，Chma
【Abstract】Objective To investigate the curative effect and safety of of holmium laser ablation in treatment of infants and young children with windpipe stenosis under bronchoscope. Methods 10 children with windpipe ste-
nosis admitted in pediatric department of Guangdong Maternal and Child Health Hospital from January 2013 to Januar-
y 2015 were e nrolled in this study，including 6 cases of endotracheal intubation after scar caused severe tracheal ste-
nosis and 4 cases of congenital tracheal web. Preoperative and postoperative assessment of clinic choscopic lesion site，blood gas analysis and chest CT changes were conducted. Results 10 cases treatment，and the results w ere significant in 8 cases，including complete removal of the windpipe stenosis，complete
removal of the lesions within the c avity，and completely improved clinical symptoms. 2 cases were effective，mclu-
ding more than or equal to 50% of the stenosis lumen dissolution of the cavity，part of the tilatory function part of the recovery，clinical symptoms of silence basically improved，and chest CT narrowin airway atelectasis and n arrow range 2/3 to 1/2. The overall effective rate was 100%. There was no serious complica-
tion during and a fter operation. Conclusion Holmium laser ablation under bronchoscopy is safe and effective in
treatment of infrarenal subglottic stenosis. It is worthy of promotion in clinical practice.
【Key words 】windpipe stenosis; laser ablation;bronchoscopy
婴幼儿气道狭窄目前主要分两类:先天性和获得 性[1]。先天性气道狭窄根据解剖结构分为先天性喉 狭窄和先天性气管狭窄。先天性喉狭窄主要以环状 软骨畸形为主，如形状异常，呈扁平、椭圆或有裂隙，或直径小于正常。先天性气管狭窄包括气管蹼、气管 发育不全或闭锁、气管软化、血管畸形压迫等。获得 性气道狭窄可由气管插管、外伤、高位气管切开、感
doi：10.3969/j.issn. 1009 -6663.2017.08.012
基金项目：广东省科技厅科技计划项目（No 2016ZC0187)
作者单位：10010广东广州，广东省妇幼保健院儿科
通信作者：彭淑梅，E-mail:pengsm2010@163. com 染、烧伤、肿瘤等原因造成，其中又以气管插管最为常 见[2]，大约有90%的声门下狭窄由此引起。目前国 内关于在这方面的治疗多采取保守或创伤较大的开 放性手术，本研究采取经支气管镜激光消融术治疗婴 幼儿气道狭窄，效果良好，现报道如下。
资料与方法
一、一般资料
选取2013年1月至2015年1月13例在广东 省妇幼保健院儿科收治气道狭窄的患儿1例，其中 气管插管后气管瘢痕引起气管重度狭窄6例;先天 性气管蹼4例。男8例，女5例，年龄在1月-4岁，