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儿童声门下区狭窄的主要原因为气管切开位置不当,损伤环状软骨及气管上端软骨环,或气管插管过久,本病治疗常不满意而成临床难题。人们多认为患儿成长后,喉气管会随之增大,也能解除狭窄,怕早期手术影响儿童喉部发育,加上儿童手术的死亡率较高,故主张采用“等待与观察”的办法。Fearon及Cotton(1974)提出,因声门下狭窄的儿童在“观望”期间有25%的死亡率,故如能使手术死亡率低于25%,即有成功意义。本文报道一例5岁女孩,因车祸造成左额骨骨折、硬脑膜下血肿,经脑外科手术后,出现神智不清、呼吸严重困难而作紧急气管切开。术后一月,神智恢复,但拔管困难。一年后门诊检查,生长发育正常,声带活动好,作喉裂开手术,发现环状软骨及1、2气管环前壁支架缺损,
Children with subglottic stenosis is mainly due to improper tracheotomy position, damage to the cartilage ring of the annular cartilage and the trachea, or tracheal intubation for too long, often not satisfied with the treatment of this disease is a clinical problem. Most people think that children grow up, the laryngotracheal tube will increase, but also to lift the stenosis, fear of early surgery affect children’s laryngeal development, coupled with higher mortality rate of child surgery, it advocates the use of “waiting and observation” approach . Fearon and Cotton (1974) suggested that children with subglottic stenosis have a 25% mortality rate during “wait and see”, so having a surgical mortality rate below 25% is of great importance. This article reports a 5-year-old girl who had an emergency tracheotomy due to a car accident that left her left frontal bone fracture, subdural hematoma, and brain surgery. January after surgery, resuscitation, but extubation difficult. A year after the outpatient examination, normal growth and development, vocal cord activity is good, for laryngeal fissure surgery, found annular cartilage and 1,2 tracheal anterior wall stent defects,