Saunders M W, Thirlwall A, Jacob A, Albert D M
Department of Otolaryngology, Southmead Hospital, University of Bristol, UK.
Int J Pediatr Otorhinolaryngol. 1999 Oct 15;50(1):51-4. doi: 10.1016/s0165-5876(99)00235-9.
To compare single-stage laryngotracheal reconstruction (SSLTR) and reconstruction with tracheostomy and indwelling stent (two-stage LTR), a retrospective review was made of 69 patients undergoing laryngotracheal reconstruction for subglottic stenosis at Great Ormond Street Hospital for Sick Children. Pre-operative details recorded included grade and aetiology of subglottic stenosis, history of previous laryngeal surgery, sex of patient and age at reconstruction. As a measure of outcome, the total number of procedures including all endoscopy and further reconstruction was recorded as well as de-cannulation rate, and the need for more than one reconstruction. The patients undergoing two-stage reconstruction tended to have more severe stenosis (mean grade = 2.56) compared to the SSLTR group (mean grade = 2.14) and were more likely to have had previous laryngeal surgery. Inevitably, the outcome after reconstruction in the two-stage patients is therefore less favourable, and direct comparison of the two groups is not statistically valid. However, multiple regression analysis reveals that single-stage reconstruction does confer a significant independent advantage over the two-stage procedure in terms of average number of post reconstruction procedures (p = 0.006), and a significant advantage in de-cannulation rate (p = 0.03). No difference was noted in the requirement for further reconstruction between the two groups. Although a two-stage procedure is still required in certain cases such as those with very severe stenosis or respiratory insufficiency, the single-stage reconstruction is the procedure of choice for uncomplicated paediatric subglottic stenosis.
为比较一期喉气管重建术（SSLTR）与气管造口术加留置支架重建术（二期喉气管重建术），我们对大奥蒙德街儿童医院69例因声门下狭窄接受喉气管重建术的患者进行了回顾性研究。记录的术前详细信息包括声门下狭窄的分级和病因、既往喉部手术史、患者性别及重建时的年龄。作为结局指标，记录包括所有内镜检查和进一步重建在内的手术总数、拔管率以及再次重建的需求。与SSLTR组（平均分级=2.14）相比，接受二期重建的患者狭窄往往更严重（平均分级=2.56），且更有可能曾接受过喉部手术。因此，二期患者重建后的结局不可避免地较差，两组之间的直接比较在统计学上无效。然而，多元回归分析显示，在重建后手术的平均次数方面（p=0.006），一期重建比二期手术具有显著的独立优势，在拔管率方面也具有显著优势（p=0.03）。两组在再次重建的需求方面未发现差异。尽管在某些情况下，如非常严重的狭窄或呼吸功能不全的患者，仍需要二期手术，但一期重建是单纯小儿声门下狭窄的首选手术方式。
