喉气管支气管软化症的研究进展

喉软化是婴儿期最常见的非传染性喘鸣的病因,内镜检查显示,吸气时声门上有异常的下垂。气管软化也可以引起慢性呼吸系统症状,主要是由于相应气管严重狭窄导致喘息,气管软化患者的主要表现是软骨环畸形。喉软化和气管软化可以并存,但是二者有所差异,现就喉软化和气管软化的病因、病理生理、诊断和治疗进行综述。     

Aryepiglottoplasty for laryngomalacia: results and recommendations following a case series of 84

OBJECTIVES: To examine one consultant's experience of aryepiglottoplasty at Leeds General Infirmary. To identify risk factors for post-operative complications. Comparing the outcomes of surgery with the published literature on aryepiglottoplasty. DESIGN: A retrospective case series of consecutive patients undergoing aryepiglottoplasty identified from theatre records. SETTING: The Otolaryngology Department, Leeds General Infirmary. This is part of Leeds Teaching Hospitals NHS Trust and is a tertiary referral centre with regional paediatric intensive care unit (PICU) and specialises in managing paediatric airway pathology. PARTICIPANTS: Ninety-one consecutive cases of aryepiglottoplasties, between 1997 and 2005. The medical records for 84 cases were reviewed. MAIN OUTCOME MEASURES: Unplanned admissions to PICU, complication rate, length of post-operative hospital stay, and successful resolution of symptoms amongst our patient group. RESULTS: The primary indication for surgery was found to be severe stridor. There was a low rate (3.6%) of unplanned admissions to the PICU. 7.1% of patients suffered a post-operative aspiration pneumonia. The majority (66.7%) of patients were able to return home after just one night in hospital. 11.9% of patients continued to have some stridor at follow-up. CONCLUSIONS: The majority of patients undergoing aryepiglottoplasty for isolated laryngomalacia can be monitored overnight on a paediatric surgical ward and return home the following day (85%). Furthermore, they should expect improvement of their stridor with a single procedure (90%). Aryepiglottoplasty at an experienced unit is a low-risk procedure with a high success rate.     

小儿喉腔三维有限元模型构建的方法及意义

目的 为预测评估小儿喉腔手术术后喉腔形态和生理功能,基于CT图像构建小儿喉腔有限元模型。 方法 用MIMICS软件对2014年8月12日、2014年10月8日和2015年10月15日住院治疗的甲状舌管囊肿患儿2例和梨状窝瘘患儿1例CT扫描得到的Dicom图像处理,以材料灰度阈值区分不同的组织结构,采用可视化处理进行三维模型重建。用ABAQUS有限元软件进行有限元网格进行划分。 结果 实验应用有限元技术,在计算机上建立了一个能够反映儿童喉腔形态特征的有限元模型。通过临床医师的辨认与比较,该模型同喉镜检查结果一致性良好。 结论 该模型形态较逼真,可用于后续模拟儿童喉腔手术、评估手术预后的研究。     

297例婴幼儿喉喘鸣的病因分析

目的 总结分析婴幼儿喉喘鸣的发病原因,以利于及时诊断和早期治疗.方法 回顾性分析2005年1月至2010年1月于我科就诊的297例喉喘鸣患儿的临床资料.所有患儿年龄≤3岁.患儿经小儿超细电子喉镜、喉三维CT或者全身麻醉状态下的支气管镜检术等检查来明确病因.结果 297例患儿中,199例(67.0％)为先天性气道结构异常,其中先天性喉结构异常的患儿有169例(84.9％,169/199),先天性气道结构异常患儿30例(15.1％,30/199);另有98例为获得性病变(33.0％,98/297).先天性喉结构异常中,喉软骨软化症最常见,共159例,占94％ (159/169);最常见的气道结构异常为气管软骨软化症,共14例,占46.7％(14/30);获得性病变中最常见为异物引起的上呼吸道阻塞病变,共64例,占65.3％ (64/98);其次为呼吸道感染,共26例,占26.5％( 26/98).结论 先天性气道结构异常为婴幼儿喉喘鸣的主要病因,其次为获得性病变,包括异物和感染.     

Pectus excavatum in children with laryngomalacia

Background

Laryngomalacia is the most common congenital laryngeal anomaly and is associated with several disorders including gastric reflux, sleep apnea, hypotonia and failure to thrive. Pectus excavatum (PE) is the most common chest wall deformity affecting 1–300/1000 individuals. Though many authors presume a relationship between PE and laryngomalacia, there is no published data to establish this association.

Goal

To test the hypothesis that patients referred to our pediatric otolaryngology clinic for evaluation of laryngomalacia exhibit higher rates of PE than the general population.

Methods

Retrospective review of prospectively enrolled children who presented with laryngomalacia (January 2008–June 2012) to a tertiary care, hospital based, pediatric otolaryngology practice. Each chart was examined for a concurrent diagnosis of pectus deformity.

Results

Of the 137 laryngomalacia patients, 9 (6.6%) had documented PE. This represents a significantly increased rate of PE when compared to children without laryngomalacia (p = 0.001). Four of the 9 children with PE underwent supraglottoplasty for laryngomalacia, a significantly greater proportion than the 9/128 of the children with isolated laryngomalacia who underwent supraglottoplasty (p = 0.004).

Conclusions

This study suggests an association between laryngomalacia and PE. Pediatric otolaryngologists should be cognizant of this relationship, though further studies are needed to elucidate the nature of this association.     

Epiglottopexy by external puncture for epiglottic prolapse in severe laryngomalacia. A novel technique

Introduction

Laryngomalacia (LM) is the first cause of stridor in infants. 10 to 20% of patients with LM may require surgery due to the development of severe symptoms. Supraglottoplasty is the most commonly performed surgery for severe LM. However, it is insufficient for the rostrocaudal displacement of the epiglottis against the posterior pharyngeal wall.