电子气管镜下应用氩气刀治疗小儿声门及声门下疾病的探讨

目的：总结电子气管镜下应用氩气刀治疗小儿声门及声门下疾病的临床经验。方法：复习文献报道，回顾性分析上海市儿童医学中心自2011年应用氩气刀技术治疗的4例声门及声门下疾病的效果及转归。结果：3例患儿声门下病变在手术后均未出现肉芽组织再次增生，未发现气道内的瘢痕和狭窄，顺利拔出气管切开的套管及气管插管，恢复正常呼吸。1例患儿室带鳞状细胞中度不典型增生，术后1个月后复查，未发现病变复发。结论：电子气管镜图像清晰，镜身细小柔软，可随意弯曲，转换角度，定位准确。而氩气刀喷头直径小，能顺利通过小儿的声门，操作精确，手术时间短，对周围正常组织无损伤，值得在小儿声门及声门下疾病的治疗中推广应用。

Application of in the man argon beam coagulator under electronic bronchoscope agement of pediatric glottic and subglottic diseases

Objective：To summarize clinical experience of application of argon knife under electronic hronchoscope in the management of pediatric glottic and subglottic diseases. Method： Reports in the literature were reviewed. Outcome and prognosis of 4 cases with pediatric glottic and subglottic diseases managed with argon beam coagulator technique in Shanghai children＇s Medical Center since 2011 were retrospectively analyzed. Result： Granulation tissue hyperplasia in 3 cases with subglottie lesions did not recur after surgery. Scarring or stenosis were not found in the airway. Intubation of the trachea and tube of traeheotomy was pulled out successfully in all cases, re- storing normal breathing. No lesion recurrence was found in 1 case with squamous cell moderate atypical hyperplasia one month after the surgery. Conclusion： Electronic bronchoscope has advantages of clear image, fine and soft lens body, optional bending, angle conversion, accurate positioning. And the argon knife with small head diameter can pass the pediatric supraglottic. It can be manipulated precisely with short operation time and no damage to surrounding normal tissues. It＇s worth in popularization and application of management for with glottic and subglottic disease in pediatric patients.