摘要目的 探讨CO2激光声门上成形术治疗重度婴幼儿喉软化症的临床效果及安全性.方法 2009年1月至2011年12月在深圳市儿童医院收治出生31～ 263 d的重度喉软化症患儿32例,依据治疗方案的不同,分为行CO2激光声门上成形术的手术组与保守治疗的对照组,每组16例,观察两组患儿症状改善及预后情况.结果 16例手术后患儿声门上塌陷得到有效纠正,术后患儿喉鸣、呼吸困难、呛咳症状迅速改善,呼吸道感染次数明显少于保守治疗的对照组.手术组患儿术后3个月时均治愈,治愈率100.0％；对照组治疗3个月时无治愈患儿,至6个月时仅1例患儿治愈,治愈率6.2％.治疗1个月、3个月、6个月时治愈率,手术组显著高于对照组,x2值分别为13.9、28.1、24.6,P值均＜0.01.治疗1个月、3个月、6个月,手术组患儿年龄别体重Z值中位数:-1.89、-0.96、-0.63；对照组-2.12、-2.17、-1.79,差异有统计学意义(z值分别为-0.848、-2.940、-4.110；P值均＜0.05或＜0.01).手术组患儿术前最低动脉血氧饱和度0.686±0.106((x)±s,下同),术后1个月0.901 ±0.041,术后显著提高,差异有统计学意义(t=-7.876,P=0.001).手术组并发症有会厌舌根粘连1例,新发短时呛咳1例,无其他严重并发症.结论 CO2激光声门上成形术治疗重度喉软化症能有效改善患儿喉鸣、呼吸困难和呛咳症状,减少患儿呼吸道感染,改善患儿生长发育,其治愈率较高,并发症较少,安全性较高.

abstractsObjective To evaluate the feasibility and safety of CO2 laser supraglottoplasty for severe laryngomalacia in infants.Methods From January 2009 to December 2011,32 infants with severe laryngomalacia were confirmed by electronic laryngoscope and clinical assessment in Shenzhen Children's Hospital.According to the choice made by the parents,16 children accepted CO2 laser supraglottoplasty (group 1),the others were treated conservatively (group 2).The beginning observation point TO was defined as the age on the first medicine taking day or the age of surgery.T1,T3,T6 were defined as 1,3,6 months following TO.Clinical symptoms included stridor,dyspnea,aspiration,and respiratory infections.The body weight,PSG reports,laryngoscope findings,cure rates of the two groups were compared.Results The anatomical abnormalities were corrected surgically,and the symptoms,such as stridor,dyspnea,and aspiration improved rapidly after the operation.The cure rates was higher in group 1 than in group 2 on T1,T3,T6 stage.There were statistically significant differences(x2 were 13.9,28.1,24.6 respectively; all P ＜ 0.01).Children in group 1 gained weight better than in group 2.There was a statistically significant difference in Z scores median on T1,T3,T6 stage (z score were-0.848,-2.940,-4.110 ; P ＜ 0.05,or P ＜ 0.01 respectively).The lowest oxygen saturation in group 1 improved one month after the surgery (from average 0.686 ±0.106 to 0.901 ±0.041).There was a statistically significant difference (t =-7.876,P =0.001).Complications included adhesion (1 case) and temporary new-onset aspiration (1 case).Conclusions The CO2 laser supraglottoplasty can resolve severe laryngomalacia symptoms including stridor,dyspnea and aspiration.It can reduce the frequency of respiratory infections,and contribute to weight gaining.The CO2 laser supraglottoplasty is effective,of high security and with rare complications.