先天性会厌囊肿临床表现及误诊分析

目的:探讨先天性会厌囊肿临床表现及误诊原因.方法:回顾性分析19例先天性会厌囊肿患儿临床表现及诊治经过.结果:19例患儿临床表现包括喉喘鸣、呼吸急促、吸气性呼吸困难、吸奶中断或呛咳、哭声低弱含混等.其中15例首诊被误诊:诊为新生儿肺炎者9例(47.4%),支气管肺炎5例(26.3%),咽喉炎1例(5.3%).所有患儿行小儿超细纤维喉镜检查后诊断为先天性会厌囊肿,并经病理证实.结论:本病临床易误诊,对于出现喉喘鸣伴有上呼吸道阻塞症状的患儿,应尽早作上呼吸道检查.小儿超细纤维喉镜检查可明确病因,及时治疗.     

儿童吸气性喉喘鸣的病因分析

目的 探讨儿童吸气性喉喘鸣的发生原因,提高儿童吸气性喉喘鸣的诊治率.方法 回顾性分析2005年1月至2007年1月深圳市儿童医院住院的吸气性喉喘鸣患儿共378例,男245例,女133例;年龄12 h～30个月,中位年龄4个月.全部病例均行胸部X线摄片检查,218例进行了胸部CT扫描、电子喉镜、直接喉镜、纤维支气管镜等检查.结果 急性喉炎140例,喉软化117例,急性喉气管支气管炎54例,声带麻痹18例,先天性气管软化9例,先天性喉蹼8例,先天性喉裂6例,喉囊肿6例,喉乳头状瘤6例,急性会厌炎4例,先天性声门下狭窄3例,气管支气管异物3例,甲状舌管囊肿1例.除先天性气管软化9例,先天性喉裂6例,先天性声门下狭窄3例,声带麻痹18例,仅给予对症治疗外,复发性喉乳头状瘤尚在治疗中,其他病例均获痊愈.结论 儿童吸气性喉喘鸣病因复杂,以急性喉炎和喉软化最为多见.由炎症引起的喉喘鸣经保守治疗可获痊愈,电子喉镜检查是喉喘鸣患儿必要的检查手段,有时需配合胸部CT和纤维支气管镜检查.     

新生儿阻塞性呼吸困难的病因分析及治疗

目的探讨新生儿阻塞性呼吸困难的病因、临床特征及治疗方法，提高新生儿阻塞性呼吸困难的诊断水平及治愈率。方法2001年3月-2004年6月深圳市儿童医院新生儿科住院的阻塞性呼吸困难的患儿共11例，男6例，女5例；出生时间为8h～28d，平均7．2d。4例发生新生儿窒息，出生后即行气管插管。3例不能发出哭声，直接喉镜检查双声带麻痹2例，多发性颅神经麻痹1例。2例饮奶不能连续，间断性呼吸困难加重，鼻部CT、MRI确诊先天性腺样体肥大、新生儿鼻炎各1例。6例持续性呼吸困难，直接喉镜检查确诊先天性会厌囊肿4例，气管镜检查确诊声门下狭窄1例，气管切开时确诊胸段气管狭窄1例。结果先天性会厌囊肿4例和先天性腺样体肥大1例，均经手术切除治愈；双声带麻痹2例和声门下狭窄1例行气管切开术，1例术后双声带活动功能恢复，拔管出院，另2例带管出院；胸段气管狭窄1例死亡，多发性颅神经麻痹1例放弃治疗。结论对新生儿阻塞性呼吸困难早期进行直接喉镜或气管镜等相关检杏．及时行病因治疗．可提高诊断及治俞率．     

喉显微外科技术在严重新生儿上气道梗阻中的应用

目的 探讨严重新生儿上气道梗阻病因、临床特征及喉显微外科手术疗效,以提高新生儿阻塞性呼吸困难的诊治水平。 方法 采用观察性研究,分析16例咽喉相关的严重上气道梗阻新生儿临床资料。 结果 共纳入患儿16例(男9例、女7例),出生后7~28 d出现临床症状,包括吸气性呼吸困难、喉喘鸣、三凹征等。其中先天性喉软化症6例、下咽及舌根囊肿3例、喉部血管瘤2例、喉入口畸胎瘤1例、先天性喉蹼1例、双声带麻痹1例、继发性声门下狭窄1例、插管后喉粘连1例。16例患儿均给予相应显微外科治疗,手术顺利。顺利拔管患儿15例,仅1例喉软化症患儿拔管后仍有明显呼吸困难,行气管切开。 结论 严重新生儿上气道梗阻多与咽喉病变相关,需早期行局部及全身检查明确病因及诊断,对有手术指征者积极采取微创手术治疗,可挽救患儿生命,取得满意疗效。     

重度先天性喉软化的外科治疗(附16例报道)

目的:探讨重度先天性喉软化的诊治方法和疗效。方法:回顾性分析16例重度先天性喉软化患儿的临床表现、诊断、手术方法及术后随访资料。根据临床表现及电子喉镜检查确诊,并依据喉软化分型采取相应的声门上成形术。结果:16例患儿平均手术年龄为23周。14例行声门上成形术,2例伴气管软化者行气管切开术。声门上成形术后48h喉喘鸣消失9例,呼吸困难解除6例,喂养困难消失7例。术后6个月随访,1例患儿因重症肺炎死亡,其余13例中喉喘鸣消失12例,改善1例;呼吸困难解除8例;喂养困难消失12例,改善1例。结论:声门上成形术能有效缓解重度喉软化所致的喉喘鸣、呼吸及喂养困难等症状,可作为重度先天性喉软化的首选外科治疗方式。     

新生儿气管插管并发声门下囊肿

长期气管插管后数周或数月,出现上呼吸道部分阻塞,其原因多为声门下区疤痕形成或狭窄,而本文报道3例却由声门下囊肿所致。患几分别在妊娠26、27、28周自然娩出,体重依次为810克、970克和900克。均因呼吸窘迫综合征或肺部感染而作鼻气管内插管及正压呼吸通气;留管时间分别为8天、7周和3周。除管后15周、7个月和2年出现呼吸困难及喘鸣,内腔镜检查发现声门下区有2～3个囊肿,经钳破后,症状消失,观察8～18个月无复发。〔讨论〕婴儿长期气管插管,当除管后立即呈现喘鸣者,归因于喉气管粘膜水肿;几周或几月后才出现喘鸣者多为声门下狭窄和喉囊肿。喉囊肿是喘鸣的重要病因,常见于1岁以内的婴幼     

儿童杓状软骨切除术

声带瘫痪是早期婴儿喉喘鸣的第二个常见病因，多达52％的患儿不能自愈，双侧声带麻痹常因呼吸困难需气管切开术。如双侧声带瘫痪经治疗仍不能技管，构状软骨切除术是选择手段之一。回顾分析接受构状软骨切除术的双侧声带瘫痪患）L30例，瘫痪原因2／3为先天性，余为后天各种因素。16例因伴发病变需气管切开术，平均年龄3．1岁（其中13例先天瘫痪在生后1月内行气管切开术）。气管切开术到构状软骨切除术时间平均为4．1年（0～12年）。构状软骨切除术术前作纤维喉镜或直达喉镜及必要的放射学与肌电图检查确诊。19例经喉正中裂开构状软骨切除术…     

小儿喉气道阻塞的诊断与处理

目的：探讨小儿喉气道阻塞的病因、临床特点及其处理方法。方法：分析6例不同原因引起喉气道阻塞息儿的临床资料,总结其临床特点及处理方法。结果：6例患儿中先天性喉囊肿3例;先天性喉蹼（声门型）1例;先天性舌根囊肿1例,先天性环状软骨畸形1例。除1例先天性舌根囊肿外余例均于术前或术中行气道切开,2例先天性喉囊肿行支撑喉镜下囊肿切除术,1例行喉裂开囊肿切除术。1例先天性舌根囊肿,表面麻醉后直接喉镜下穿刺抽取囊液。1例先天性喉蹼行支撑喉镜下CO2激光切除喉蹼,4例患儿均于术后1周堵管,堵管2周拔管。1例先天性环状软骨畸形予喉裂开置喉模术,术后7周堵管,现术后2个月,堵管随访中。结论：小儿喉气道阻塞在明确病因后应早期积极采取适当的手术治疗方法,去除狭窄、重建气道,对改善通气和发音、恢复小儿正常的喉气道功能极其重要。     

婴儿先天性会厌囊肿的外科治疗

先天性会厌囊肿是一种少见的胚胎性疾病，属于先天性喉黏液囊肿，在新生儿中发生率约为2／100000，临床表现以反复突发性呼吸困难乃至窒息，出生后伴有喉喘鸣。进食呛咳及呕吐为主要特征，如果延误诊断和治疗，往往会影响新生儿的生长发育甚至导致其窒息死亡。现将深圳市儿童医院耳鼻咽喉科2001-01—2007—09收治的13例先天性会厌囊肿患儿的资料报告如下。     

先天性喉异常

耳鼻咽喉科医师要诊察有喘鸣的婴儿和新生儿,必须熟悉先天性喉异常的诊断和处理。喘鸣是先天性喉病的主症,因此其病因的准确诊断最为重要。诊断病史和体检:婴儿喘鸣常伴有呼吸窘迫,因此医生必须注意不伴有气道梗阻的各种呼吸窘迫的原因,如颅内出血、大的腹腔包块、神经肌疾病、膈异常、肺囊肿、纵隔气肿、气胸、呼吸窘迫综合征、新生儿一过性呼吸急促、胎粪吸入及心脏异常等。起病的时间是重要的,如出生时即有喘鸣,最可能为先天性喉软化、先天性喉异常、单侧声带麻痹或血管环。双侧声带麻痹最多     

Lobular capillary hemangioma of the neonatal larynx

OBJECTIVE: To describe a previously unreported condition of the neonatal larynx. DESIGN: Case series of 4 neonates with an uncommon laryngeal lesion. SETTING: Tertiary care children's hospital. PATIENTS: Four neonates in the first 10 days of life with stridor, hoarseness, and respiratory distress. INTERVENTION: The patients were examined using flexible fiberoptic laryngoscopy, and laryngeal lesions were identified and subsequently removed using microlaryngoscopy. Photodocumentation of the lesions was performed. Microscopic evaluation of biopsy specimens by a pathologist followed. MAIN OUTCOME MEASURES: Each patient's medical record was carefully reviewed for prenatal history, birth history, neonatal history, pathologic findings, and office follow-up. RESULTS: All 4 neonates were delivered atraumatically and developed symptoms of upper airway obstruction within the first few minutes to days of life. Each neonate was found to have an obstructive laryngeal lesion requiring surgical intervention. No child had other congenital abnormalities or a history of obvious laryngeal trauma. Pathologic review of each laryngeal specimen revealed inflammatory lesions with characteristic features of a lobular capillary hemangioma (or a pyogenic granuloma). CONCLUSIONS: The diagnosis of a lobular capillary hemangioma of the larynx should be considered in the differential diagnosis of a newborn with stridor, hoarseness, or respiratory distress. The cases seem to be of congenital origin, although acquired pathogenesis cannot be ruled out. Treatment of these lesions includes microscopic surgical excision.     

Congenital laryngeal saccular cyst of the newborn

Congenital laryngeal saccular cysts of the newborn frequently cause severe dyspnea and upper respiratory tract obstruction. When confronted with this emergency situation necessary therapeutic action may consist of intubation, puncture or incision to reduce the volume of the cyst or tracheotomy. The CO₂ laser was effectively used not only to incise the supraglottic saccular cyst but also to vaporize the lining.     

Quiste sacular congénito de laringe: una causa rara de estridor en neonatos y lactantes

Stridor is a noise caused by the passage of turbulent air through a diminished airway caliber. Laryngomalacia is the most common congenital anomaly of the larynx and the principal cause of stridor in children under 6 months.A less common etiology of stridor and respiratory distress in newborns and infants is congenital laryngeal saccular cyst. This entity should be considered in the differential diagnosis of stridor. Early recognition and proper treatment are essential because it can cause life-threatening airway obstruction.We describe our experience with 4 patients with this disease, 3 of them successfully treated with microsurgical resection of the cyst, and we emphasize the importance of considering the endoscopic evaluation of the airway in every child exhibiting stridor with an unexpected evolution to determine the causal lesion.     

Vallecular cyst as a rare cause of progressive inspiratory stridor

BACKGROUND: Vallecular cysts are frequently observed, benign masses of the upper aerodigestiv tract. Usually they appear as harmless and asymptomatic and go unnoticed by the patient. In rare cases, obstructions of the upper airway due to monstrous vallecular cysts may become life threatening. CASE: We report on a 69-year-old otherwise healthy woman with a rapidly progressive history of dyspnea caused by a pedicled vallecular cyst. Increasing stridor prompted emergency surgical resection. CONCLUSION: Vallecular cysts that increase in size can cause dyspnea due to obstruction of the aditus of the larynx. This case demonstrates the need for surgical treatment at an early stage of pedicled vallecular cysts.     

Congenital laryngeal cyst in infancy. A rare cause of life-threatening stridor

An unusual cause of life-threatening stridor in infancy due to a congenital lateral saccular cyst of the larynx in association with an upper respiratory infection is presented. The literature is reviewed. The histopathogenesis, classification, clinical manifestations, and therapeutical principles of congenital laryngeal cysts are discussed. As almost 50% of the reported cases of congenital laryngeal cysts were diagnosed at autopsy, the gravity and importance of early recognition of these lesions must be stressed to the pediatrician and otolaryngologist.     

Airway obstruction caused by a congenital epiglottic cyst

Congenital epiglottic cyst is a rare affliction with potential for airway obstruction. A newborn boy was referred to our department for evaluation of respiratory distress and inspiratory stridor 7 h after birth. Through a transnasal fiberoptic laryngoscopy examination, a diagnosis of an obstructive upper laryngeal cyst was made. Immediate endoscopic surgery was performed 20 h after birth to completely remove the lesion. Two days after surgery, the patient resumed normal breathing pattern and showed no further episodes of stridor or airway obstruction.     

Congenital laryngeal stridor

We reviewed the diagnosis, complications and treatment of congenital laryngeal stridor (CLS), in 97 patients who consulted our clinic between 1991 and 2001. The 97 patients were diagnosed with laryngeal malacia (32%), vocal cord paralysis and laryngeal stenosis (22%), a neoplastic disease like hemagioma and papilloma (11%), or cystic disease (7%). The cases with vocal cord paralysis, laryngeal stenosis or laryngeal cysts were usually diagnosed within 2 months of birth based on severe dyspnea. Two of the 31 cases of laryngeal malacia and 2 of the 22 cases of vocal cord paralysis were associated with neuromuscular disorders. Three patients suffered from vocal cord paralysis complicated by laryngeal stenosis. Thirty-three of the 97 cases required a tracheostomy; these 33 cases included the one case of laryngeal papilloma (100%), 9 of the 10 cases of hemangioma (90%), and 18 of the 24 cases of laryngeal stenosis (75%). Since any disorders of the upper airway can potentially induce stridor, establishing an accurate diagnosis is sometimes difficult when stridor is the only presenting symptom. Hence, information on associated symptoms and the past history of the subject is particularly important for an accurate diagnosis. In addition, decisions regarding the course of treatment course require adequate consideration of possible complications.