纤维喉镜在喉喘鸣诊断中的应用

目的:探讨纤维喉镜在喉喘鸣诊断中的应用价值.方法:回顾性分析130例以喉喘鸣为主要症状就诊的患儿的临床资料.130例患儿均接受纤维喉镜检查.结果:经纤维喉镜检查发现,130例患儿中先天性喉喘鸣73例,先大性喉噗2例,会厌囊肿5例,舌根部囊肿或肿块20例,喉气囊肿1例,喉乳头状瘤3例.一侧或舣侧披裂关节活动差9例.未发现任何异常17例.结论:单纯先灭性喉喘鸣易误诊,必须排除其他引起喉喘呜的疾病.建议将纤维喉镜作为喉喘呜患儿就诊时必须的常规检查,必要时可辅助喉部CT和(或)MRI检查.     

新生儿重度上呼吸道梗阻的病因分析

目的了解新生儿重度上呼吸道梗阻的原因。方法回顾性分析47例发生重度吸气性呼吸困难的新生儿的临床表现、直接喉镜、CT、上消化道造影等检查结果及治疗经过。结果47例中先天性疾病占87．2％（41／47）：先天性喉喘鸣15例，占31．9％，其中6例伴有胃食管反流；上呼吸道先天性囊肿14例（舌根囊肿10例，会厌囊肿3例，喉囊肿1例），占29．8％，其中有13例曾被误诊为先天性喉喘鸣；先天性总气管狭窄3例；先天性喉蹼2例；声带麻痹2例；皮耶-罗宾综合征3例；猫叫综合征2例。急性膜性喉气管支气管炎6例。47例中3例放弃治疗，44例经吸氧、药物治疗后呼吸困难缓解，其中曾行气管插管、吸痰37例次，行直接喉镜、支撑喉镜手术19例次。结论新生儿重度上呼吸道梗阻病因以先天性疾病为主，对这类患儿应及时进行相关检查，尽早明确病因，迅速解除梗阻，以降低新生儿死亡率和预防不良后遗症的发生。     

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.     

喉软化及其治疗

喉软化是婴儿喘鸣最常见的原因 ,约 70 %患儿无需治疗而在 1岁左右能自愈。该文回顾性分析了 1990～ 1998年间 58例经纤维喉镜确诊的喉软化患儿 ,以了解未行直接喉镜或支气管镜检查的患儿其气道状况 ,喉软化治愈的时间 ,声门上成形术与喉软化的类型及其它合并症间的关系。患儿平均发病年龄为 2 .2周 ,其中 2 7例伴有其它先天性疾病 ,如神经系疾病、呼吸道其它病变、胃食管返流症等。纤维喉镜下将喉软化分为三型。 型 :杓状软骨粘膜脱垂 ,占 57% ; 型 :杓会厌襞缩短 ,占 15% ; 型 :会厌后移 ,占 12 %。部分患儿为 型和 型的混合型 ,约占 1…     

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。     

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。     

先天性会厌囊肿1例

先天性会厌囊肿１例郭兰英１患儿，女。１９９６年１月９日因胎儿臀位、宫内窘迫，行剖宫，产后紫绀、哭声低，呼吸困难，鼻翼扇动，喘鸣。而于１９９６年元月１１日上午９时转入我院，检查两肺密集细小水泡音，心腹正常，直接喉镜检查见会厌舌面左上方近会厌谷处有一１...     

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。     

小儿会厌囊肿的现状评价和治疗进展

小儿会厌囊肿是婴幼儿罕见的上呼吸道先天性病变,可导致生长发育迟缓和危及生命的气道阻塞,发病早期会出现喉鸣、气道阻塞以及喂养困难等症状。患儿常因同时伴有喉软化而延误诊断。放射学和内镜的联合诊断比单一的诊断手段更具有特异性。本文对小儿先天性会厌囊肿的流行病学、胚胎病理学、临床分类及特征表现、鉴别诊断、诊断评估、病理学诊断、治疗和预后的研究进展做一综述。     

新生儿先天性会厌囊肿1例

患儿,女,17d。因呼吸困难伴吸气性喘鸣14d,于2010年12月22日入院。患儿17d前剖腹产出生,生后3d无明显诱因出现呼吸困难伴吸气性喘鸣,平卧及侧卧位喘鸣无改善,不伴憋气,无口唇发绀,无饮食饮水呛咳。纤维喉镜检查示会厌囊肿。入院查体:体温36.5℃,脉搏120次/min,     

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.     

Clinical characteristics and surgical treatment outcomes of vallecular cysts in adults

Conclusion: It is suggested that transoral complete excision is the ideal treatment for adult vallecular cyst to avoid life-threatening acute airway obstruction and disease recurrence. Objective: The objective of this study was to review the clinical characteristics and surgical treatment outcomes of vallecular cysts in adults. Methods: A retrospective chart review was performed at Chonnam National University Hwasun Hospital from January 2009 to December 2014. Results: Nine patients (≥ 19-years-of-age) with a vallecular cyst were identified. Most of the patients had minimal or no symptoms at diagnosis. The presence of a vallecular cyst was confirmed in all of the patients by fiberoptic laryngoscopy. All of the cases with a vallecular cyst were treated by the transoral surgical procedure. Recurrence of the vallecular cyst was identified in two (22.2%) patients. One patient had been disease-free after the third operation through the transoral approach. Another patient who underwent marsupialization has been observed without surgery. There were no major complications resulting from surgical intervention.     

Vallecular cyst in an infant: does your specimen show D2-40 immunoreactivity?

Vallecular cysts are infrequent causes of supraglottic obstruction causing stridor and swallowing difficulty in infants. When detected early in life, the management consists of marsupialization or resection. Supraglottic lymphangiomas of the tongue base and vallecula present with similar symptoms and time of presentation. Endoscopic visualization is traditionally considered to be sufficient in identifying and differentiating these. When a vallecular cyst is visually diagnosed by the surgeon during endoscopy, surgical treatment is provided at the same time. Obtaining a specimen is rarely considered for histopathologic diagnostic verification. However, the natural presentation of a cystic lymphangioma may be indistinguishable from a solitary vallecular cyst by endoscopy alone. This case presentation argues in favor of histopathologic diagnosis in vallecular cysts because the 2 may represent a continuum of disease. A vallecular mass with a single large mucus-filled cyst and adjoining edematous soft tissue extension into the tongue base and piriform sinus diagnosed as lymphangioma through D2-40 immunoreactivity is presented.     

Diagnosis and treatment of pediatric vallecular cysts and pseudocysts

Objective

To review the experience at a children's hospital diagnosing and treating vallecular cysts.

Secondary objectives

To determine if cyst type, operative mode, or ages are risk factor(s) for recurrence.

Methods

Chart review of eleven children with vallecular cysts and pseudocysts from 1997 to 2009.

Results

The most common presenting symptoms were stridor (8/12, 67%), respiratory distress (7/12, 58%), and feeding difficulties (4/12, 33%). Symptoms of gastroesophageal reflux disease were present in 67% of patients and 17% carried a concurrent diagnosis of laryngomalacia. Eleven of twelve patients required operative intervention, the majority of which were transoral endoscopic procedures. Three patients (3/11, 27%) had recurrences. Two of these patients required only a second procedure, but one patient required multiple procedures. Fifty percent (2/4) of the patients 2 years or older experienced a recurrence, whereas only 14% (1/7) of the patients less than 2 years old had a recurrence, a difference which was not statistically significant (p = 0.49). Pseudocysts tended to recur more frequently than vallecular cysts. (p = 0.13). Surgical approach (marsupialization versus total excision) did not affect recurrence rate. One patient with a small, asymptomatic cyst was observed and continues to be symptom-free. There were no surgical complications.

Conclusions

Vallecular cysts and pseudocysts are rare congenital lesions of the upper aerodigestive tract. Vallecular pseudocysts tended to recur more than vallecular cysts in our series. Surgery is the treatment of choice for symptomatic patients; smaller cysts may be followed closely.     

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.     

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．     

Cysts of the infant larynx

We report the largest single-centre series in the literature of laryngeal cysts in infants. Most of these children presented with stridor within the first two weeks of life, and were found to have a supraglottic or vallecular cyst. Early endoscopic de-roofing of the cyst is the recommended form of treatment.     

婴幼儿吸气性喉喘鸣病因分析与治疗

目的 分析婴幼儿吸气性喉喘鸣的发病原因,探讨其有效治疗方法。方法 回顾性分析2009年7月至2012年7月于我科就诊的256例吸气性喉喘鸣患儿的临床资料。结果 256例中,162例(63.3％)为先天性喉气道结构异常,50例(19.5％)为占位性病变,11例(4.3%11/256)为神经性疾病-声带麻痹,33例(12.9％33／256)为获得性病变引起的上呼吸道阻塞。结论 喉软骨软化症仍是0~2岁婴儿吸气性喉喘鸣的主要病因,随着月龄增长有自愈的倾向;其他喉部病变也是吸气性喉喘鸣的重要病因。诊断需借助辅助检查,应尽早明确;针对不同病因采取不同的治疗方案