目的评价纤维支气管镜(FB)引导下气管扩张术治疗婴儿声门下狭窄(SGS)的效果及安全性。方法收集本院2004年1月-2009年6月经FB检查确诊的SGS病例27例。给予保守治疗,或FB引导下,将不同型号的气管插管作为扩张器,逐渐增大管径行气管扩张术治疗。比较患儿的一般资料、首次镜检结果、气管扩张次数、扩张时不良反应、总治疗时间、随访情况等,比较不同程度SGS及不同性质SGS的扩张次数及治疗时间。结果共23例患儿完成治疗及随访。Ⅰ度SGS 5例、Ⅱ度SGS 10例、Ⅲ度SGS 8例。病例均为先天性心脏病手术麻醉气管插管后获得性SGS。4例Ⅰ度SGS患儿给予观察及内科治疗,未行气管扩张术;余19例患儿因梗阻性呼吸困难立即行气管扩张术,无严重不良反应;除1例患儿入院前因在巴西手术后患SGS已行气管切开术,其余病例均未行气管切开术。所有病例扩张次数为1~6(2.17±1.59)次,Ⅰ度、Ⅱ度及Ⅲ度SGS患儿扩张次数分别为(0.40±0.89)次、(2.70±1.16)次、(2.63±1.69)次,三者比较差异有统计学意义(P=0.013),但Ⅱ度与Ⅲ度比较差异无统计学意义(P=0.762)。所有病例治疗时间为0.5~6.0(1.33±1.27)个月,Ⅰ度、Ⅱ度及Ⅲ度SGS患儿治疗时间分别为(0.80±0.67)个月、(1.22±0.50)个月和(2.21±1.66)个月,三者比较差异有统计学意义(P=0.007),Ⅱ度与Ⅲ度比较差异无统计学意义(P=0.395)。膜状狭窄及硬疤痕并肉芽样狭窄病例的扩张次数比较差异无统计学意义(P=0.727)。随访时间2~66个月,平均17.5个月。2例患儿分别于扩张术后2个月及3个月因先天性心脏病术后并发症死亡,但无梗阻性呼吸困难;其余病例均生存良好,且无明显呼吸道梗阻症状。结论 FB检查能早期诊断婴儿SGS。在FB引导下,将不同型号的气管插管作为扩张器行气管扩张术治疗SGS简单易行、安全可靠,且经济有效,可避免气管切开威胁儿童生命及造成生存质量低下。 Objective To evaluate the efficacy and safety of tracheal dilation guided by fibrobronchoscopy (FB) in the treatment of infantile subglottic stenosis (SGS). Methods Twenty-seven cases of SGS diagnosed by FB in our hospital from January 2004 to June 2009 were collected. To give conservative treatment, or FB guidance, the different types of endotracheal intubation as a dilator, and gradually increase the diameter of the line of tracheal dilation treatment. Compare the general data, the first microscopic examination results, the number of tracheal dilation, the adverse reactions during dilation, the total treatment time, the follow-up, etc., to compare the number of SGS and different types of SGS dilation and treatment time. Results A total of 23 children completed the treatment and follow-up. Ⅰ degree SGS 5 cases, Ⅱ degree SGS 10 cases, Ⅲ degree SGS 8 cases. All cases were congenital heart surgery anesthesia after intubation acquired SGS. 4 cases of I-degree SGS children given observation and medical treatment, no tracheal expansion; more than 19 cases of patients with obstructive dyspnea immediately tracheotomy, no serious adverse reactions; except 1 case of children with pre-admission in Brazil SGS had tracheotomy after surgery, and the rest had no tracheotomy. The number of dilatation in all cases was 1 ~ 6 (2.17 ± 1.59) times. The number of dilatation in children with grade Ⅰ, Ⅱ and Ⅲ SGS was (0.40 ± 0.89) times, (2.70 ± 1.16) times and (2.63 ± 1.69) times (P = 0.013), but there was no significant difference between Ⅱ and Ⅲ (P = 0.762). The treatment time was 0.5 to 6.0 (1.33 ± 1.27) months in all cases, and the duration of treatment was (0.80 ± 0.67) months, (1.22 ± 0.50) months and (2.21 ± 1.66) months, the difference between the three was statistically significant (P = 0.007), there was no significant difference between the second degree and the third degree (P = 0.395). There was no significant difference in the number of expansion between membranous stenosis, hard scars and granulomatous stenosis (P = 0.727). Follow-up time of 2 to 66 months, an average of 17.5 months. Two patients died of postoperative complications of congenital heart disease at 2 months and 3 months after dilatation, respectively, but no obstructive dyspnea. The remaining cases all survived with no symptoms of respiratory tract obstruction. Conclusion FB can diagnose infant SGS early. Under the guidance of FB, different types of endotracheal intubation as a dilator tracheostomy for SGS treatment is simple, safe, reliable and cost-effective, which can prevent tracheotomy from threatening the life of children and resulting in poor quality of life.