特发性声门下狭窄临床诊治附4例报道
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摘要
目的:探讨特发性声门下型喉狭窄的发病机制及临床诊治方法。方法:对我科2012年5月-2014年1月收治的4例特发性声门下型喉狭窄患者的临床资料进行回顾性研究,在基本相同的手术方式、不同的术后用药下进行长期随访,电子喉镜下观察患者术前、后及随访2年的病灶区情况并进行相关统计学分析。结果:4例特发性声门下型喉狭窄患者多因呼吸困难就诊,均采用气管切开术及支撑喉镜下热器械切除病变,旷置创面的手术方式,术后短期内气道狭窄均得到解决、呼吸困难症状均得到缓解;配合小剂量激素中长期治疗效果尚可,患者声门下病灶无明显复发,气道症状能得到控制,其中2例患者治愈,1例患者因拒绝激素治疗术后未予激素治疗中期观察有效,1例患者术中术后未予激素治疗,术后短期复发,后经激素治疗治愈。结论:特发性声门下型喉狭窄是后天性声门下狭窄的非瘢痕性的特殊类型,为独特的喉狭窄炎症性疾病,病因不明或为某些因素引起了非特异的增生性炎症,表现为炎性细胞的浸润及淋巴组织增生。治疗上,手术能明显缓解其症状,但单纯手术治疗中长期效果不佳,极易复发;配合中长期小剂量激素治疗对病灶控制有重要的作用。
Objective: To investigate the clinical diagnosis and treatment of idiopathic subglottic stenosis. Methods: From May2012 to January 2014, four patients with idiopathic subglottic stenosis admitted in the Department of Otolaryngology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China were selected for review. Results: All the four patients with idiopathic subglottic stenosis were resolved after the resection of the pathological tissues and subsequent hormone treatment.Con clusions: The confirmed diagnosis of idiopathic subglottic stenosis mainly relied on the medical history and pathological examination. Favorable treatment effects might be obtained by combining surgical resection and hormone treatment.
Objective: To investigate the clinical diagnosis and treatment of idiopathic subglottic stenosis. Methods: From May2012 to January 2014, four patients with idiopathic subglottic stenosis admitted in the Department of Otolaryngology, the Affiliated Drum Tower Hospital of Nanjing University Medical School, Nanjing, Jiangsu, China were selected for review. Results: All the four patients with idiopathic subglottic stenosis were resolved after the resection of the pathological tissues and subsequent hormone treatment.Con clusions: The confirmed diagnosis of idiopathic subglottic stenosis mainly relied on the medical history and pathological examination. Favorable treatment effects might be obtained by combining surgical resection and hormone treatment.
引文
[1]Garini G,Fecci L,Giacosa R,et al.Adult idiopathic subglottic stenosis:a diagnostic and therapeutic challenge.Annali Italiani di Medicina Interna,2004,19(1):54-57
[2]Damrose EJ.On the development of idiopathic subglottic stenosis[J].Med Hypotheses,2008,71(1):122-125
[3]Maldonado F,Loiselle A,Depew ZS,et al.Idiopathic subglottic stenosis:an evolving therapeutic algorithm[J].Laryngoscope,2014,124(2):498-503
[4]Hseu AF,Benninger MS,Haffey TM,et al.Subglottic stenosis:a ten-year review of treatment outcomes[J].Laryngoscope,2014,124(3):736-741
[5]Lewis S,Earley M,Rosenfeld R,et al.Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis[J].Laryngoscope,2016[Epub ahead of print]
[6]Gelbard A,Donovan DT,Ongkasuwan J,et al.Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis[J].Laryngoscope,2016,126(6):1390-1396
[7]Gelbard A,Katsantonis NG,Mizuta M,et al.Idiopathic subglottic stenosis is associated with activation of the inflammatory IL-17A/IL-23 axis.Laryngoscope,2016,126(11):E356-E361
[8]Gelbard A,Katsantonis NG,Mizuta M,et al.Molecular analysis of idiopathic subglottic stenosis for Mycobacterium species.Laryngoscope,2016[Epub ahead of print]
[9]Valdez TA,Shapshay SM.Idiopathic subglottic stenosis revisited[J].Annals of Otology,Rhinology&Laryngology,2002,111:690-695
[10]Dedo HH,Catten MD.Idiopathic progressive subglottic stenosis:覱ndings and treatment in 52 patients[J].Annals of Otology,Rhinology&Laryngology,2001,110:305-311
[11]Lorenz RR.Adult laryngotracheal stenosis:etiology and surgical management[J].Current Opinion in Otolaryngology&Head and Neck Surgery,2003,11:467-472
[12]Park SS,Streita SJ,Rebeiz EE,et al.Idiopathic subglottic stenosis[J].Archives of Otolaryngology-Head and Neck Surgery,1995,121(8):894-897
[13]Hans S,Mones E,Biacabe B,et al.Idiopathic subglottal stenosis the adult[J].Ann Otolaryngol Chir Cervicofac,1999,116(5):250-256
[14]Giudice M,Piazza C,Foccoli P,et al.Idiopathic subglottic stenosis:management by endoscopic and open-neck surgery in a series of 30patients[J].European Archives of Oto-Rhino-Laryngology,2003,260(5):235-238
[15]Rahimah AN,Shahfi FI,Masaany M,et al.Tracheal T-tube:a novel endoscopic insertion technique[J].The Journal of Laryngology&Otology,2016,130(10):967-968
[16]Fiorelli A,Mazzone S,Costa G,et al.Endoscopic treatment of idiopathic subglottic stenosis with digital Acu Blade robotic microsurgery system.The Clinical Respiratory Journal,2016[Epub ahead of print]
[17]Wierzbicka M,Tokarski M,Puszczewicz M,et al.The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology.The Journal of Laryngology&Otology,2016,130(7):674-679
[18]Chen WN,Deng YM,Guo WH,et al.Laryngeal Function Reconstruction Using Cryogenically Frozen Tissue Engineering Cartilage[J].Progress in Modern Biomedicine,2011,11(23):4441-4443
[19]Rees LE,Ayoub O,Haverson K,et al.Differential major histocompatibility complex class II locus expression on human laryngeal epithelium[J].Clinical&Experimental Immunology,2003,134:497
[2]Damrose EJ.On the development of idiopathic subglottic stenosis[J].Med Hypotheses,2008,71(1):122-125
[3]Maldonado F,Loiselle A,Depew ZS,et al.Idiopathic subglottic stenosis:an evolving therapeutic algorithm[J].Laryngoscope,2014,124(2):498-503
[4]Hseu AF,Benninger MS,Haffey TM,et al.Subglottic stenosis:a ten-year review of treatment outcomes[J].Laryngoscope,2014,124(3):736-741
[5]Lewis S,Earley M,Rosenfeld R,et al.Systematic review for surgical treatment of adult and adolescent laryngotracheal stenosis[J].Laryngoscope,2016[Epub ahead of print]
[6]Gelbard A,Donovan DT,Ongkasuwan J,et al.Disease homogeneity and treatment heterogeneity in idiopathic subglottic stenosis[J].Laryngoscope,2016,126(6):1390-1396
[7]Gelbard A,Katsantonis NG,Mizuta M,et al.Idiopathic subglottic stenosis is associated with activation of the inflammatory IL-17A/IL-23 axis.Laryngoscope,2016,126(11):E356-E361
[8]Gelbard A,Katsantonis NG,Mizuta M,et al.Molecular analysis of idiopathic subglottic stenosis for Mycobacterium species.Laryngoscope,2016[Epub ahead of print]
[9]Valdez TA,Shapshay SM.Idiopathic subglottic stenosis revisited[J].Annals of Otology,Rhinology&Laryngology,2002,111:690-695
[10]Dedo HH,Catten MD.Idiopathic progressive subglottic stenosis:覱ndings and treatment in 52 patients[J].Annals of Otology,Rhinology&Laryngology,2001,110:305-311
[11]Lorenz RR.Adult laryngotracheal stenosis:etiology and surgical management[J].Current Opinion in Otolaryngology&Head and Neck Surgery,2003,11:467-472
[12]Park SS,Streita SJ,Rebeiz EE,et al.Idiopathic subglottic stenosis[J].Archives of Otolaryngology-Head and Neck Surgery,1995,121(8):894-897
[13]Hans S,Mones E,Biacabe B,et al.Idiopathic subglottal stenosis the adult[J].Ann Otolaryngol Chir Cervicofac,1999,116(5):250-256
[14]Giudice M,Piazza C,Foccoli P,et al.Idiopathic subglottic stenosis:management by endoscopic and open-neck surgery in a series of 30patients[J].European Archives of Oto-Rhino-Laryngology,2003,260(5):235-238
[15]Rahimah AN,Shahfi FI,Masaany M,et al.Tracheal T-tube:a novel endoscopic insertion technique[J].The Journal of Laryngology&Otology,2016,130(10):967-968
[16]Fiorelli A,Mazzone S,Costa G,et al.Endoscopic treatment of idiopathic subglottic stenosis with digital Acu Blade robotic microsurgery system.The Clinical Respiratory Journal,2016[Epub ahead of print]
[17]Wierzbicka M,Tokarski M,Puszczewicz M,et al.The efficacy of submucosal corticosteroid injection and dilatation in subglottic stenosis of different aetiology.The Journal of Laryngology&Otology,2016,130(7):674-679
[18]Chen WN,Deng YM,Guo WH,et al.Laryngeal Function Reconstruction Using Cryogenically Frozen Tissue Engineering Cartilage[J].Progress in Modern Biomedicine,2011,11(23):4441-4443
[19]Rees LE,Ayoub O,Haverson K,et al.Differential major histocompatibility complex class II locus expression on human laryngeal epithelium[J].Clinical&Experimental Immunology,2003,134:497