Objective: To discuss the surgical safeness of the cleft palate children with airway stenosis by means of analyzing characteristics of the shape of the upper airway and comparing clinical data of cleft palate children with airway stenosis and non-airway stenosis. Methods: Tracing back from Apirl 2015 to Apirl 2017, 126 cleft palate children treated in Shanghai Children's Medical Center, Shanghai Jiao Tong University School of Medicine, were included (46 male and 80 female, age of 7 to 74 months, median age 18 months). According to the spiral CT scan of neck, patients were categorized to airway-stenosis group (65 patients) and non-airway-stenosis group (61 patients). For airway-stenosis group, suspected difficult intubation plan is applied, guiding endotracheal intubation via visible laryngoscope. For non-airway-stenosis group, ordinary plan of endotracheal intubation is applied. Study the statistics of both groups in the measurement of the upper airway, the success rate of tracheal intubation, operation time, hospital day. Results: Based on anatomical location of the airway stenosis, cleft palate children were divided into: nasopharynx, 5 cases; laryngel, 55 cases; initiation part of trachea to arch of aorta, 2 cases; arch of aorta to bronchial bifurcation, 3 cases. Regardless of airway stenosis, the upper airway of cleft palate children in the subglottic area and the cricoid area was elliptical, with the transverse dimension narrow and the anteroposterior dimension wide. Comparing to non-airway-stenosis group, the airway in airway-stenosis group remained narrower in the anteroposterior dimension in the subglottis area [(7.69±1.76) mm]; also remained narrower in the transverse dimension [(5.96±1.27) mm] and the anteroposterior dimension [(8.16±1.31) mm] in the cricoid area (P<0.05). Pre-and post-operative monitor blood oxygen saturation of all patients were normal. Ventilator weaning of all patients was successful. There were no statistical significance in operation time and hospital day between airway-stenosis group and non-airway-stenosis group (P>0.05). Conclusions: The upper airway of the subglottic area and the cricoid area in cleft palate children are elliptical, with the transverse dimension narrow and the anteroposterior dimension wide. Cleft palate children with airway stenosis underwent surgery smoothly by using a portable visible laryngoscope.
目的： 通过分析腭裂患儿螺旋CT气管形态特征，比较气管狭窄与非气管狭窄患儿的临床资料，探讨气管狭窄患儿的手术安全性。 方法： 回顾性分析2015年4月至2017年4月上海交通大学医学院附属上海儿童医学中心普外科收治的126例腭裂患儿，男性46例，女性80例，年龄7~74个月（中位年龄18个月）。根据颈部螺旋CT，分为气管狭窄组（65例）和非气管狭窄组（61例）；麻醉科针对气管狭窄组采取疑似困难插管预案，使用可视性喉镜指导气管插管；针对非气管狭窄组常规实施气管插管。统计比较两组气管形态、手术时间、住院天数等临床资料。 结果： 气管狭窄组患儿根据狭窄部位分为鼻咽部狭窄5例、喉部狭窄55例、气管起始部至主动脉弓层面狭窄2例和主动脉弓层面至气管分叉层面狭窄3例。腭裂患儿不论气管有无狭窄，上气道声门下水平和环状软骨水平截面的横径窄，前后径宽，上气道均呈椭圆形。与非气管狭窄组相比，气管狭窄组声门下水平截面的前后径更小[（7.69±1.76）mm]，环状软骨水平截面的横径[（5.96±1.27）mm]和前后径[（8.16±1.31）mm]均更小（P<0.05）。两组术前血氧饱和度均正常，两组均成功实施手术，术后即刻顺利撤机。两组手术时间、住院天数差异均无统计学意义（P>0.05）。 结论： 腭裂患儿气管声门下水平和环状软骨水平截面均呈椭圆形，其横径窄而前后径宽；对合并气管狭窄的腭裂患儿采用可视性喉镜指导气管插管均可获得良好疗效。.
Keywords: Airway management; Airway stenosis; Cleft palate; Tomography, spiral computed.