Gustafson L M, Hartley B E, Liu J H, Link D T, Chadwell J, Koebbe C, Myer C M, Cotton R T
Department of Pediatric Otolaryngology-Head and Neck Surgery, Children's Hospital Medical Center, Cincinnati, USA.
Otolaryngol Head Neck Surg. 2000 Oct;123(4):430-4. doi: 10.1067/mhn.2000.109007.
We reviewed our experience with pediatric single-stage laryngotracheal reconstruction (SSLTR) to identify factors that affect postoperative outcomes, including the need for reintubation and tracheostomy.
Retrospective chart review was done.
In total, 190 children underwent 200 SSLTRs; 29% were reintubated, and 15% required postoperative tracheostomy. Currently, 96% are decannulated. The use of anterior and posterior costal cartilage grafting, age less than 4 years, sedation for more than 48 hours, a leak pressure around the endotracheal tube at greater than 20 cm H2O, and moderate/severe tracheomalacia significantly increased the rate of reintubation. The duration of stenting did not affect outcomes. Children with anterior and posterior grafts and those with moderate or severe tracheomalacia were more likely to need a postoperative tracheostomy.
SSLTR can be effective for the treatment of pediatric laryngotracheal stenosis. Diligent preoperative assessment of the patient and the patient's airway and close postoperative care are important to the success of this operation.
我们回顾了小儿单阶段喉气管重建术（SSLTR）的经验，以确定影响术后结果的因素，包括再次插管和气管造口术的需求。
进行回顾性病历审查。
共有190名儿童接受了200次SSLTR手术；29%的患儿需要再次插管，15%的患儿术后需要气管造口术。目前，96%的患儿已拔管。使用前后肋软骨移植、年龄小于4岁、镇静超过48小时、气管导管周围漏气压力大于20 cm H2O以及中度/重度气管软化症显著增加了再次插管率。支架置入时间不影响手术结果。接受前后移植的患儿和患有中度或重度气管软化症的患儿更有可能需要术后气管造口术。
SSLTR对小儿喉气管狭窄的治疗可能有效。对患者及其气道进行细致的术前评估以及术后密切护理对该手术的成功至关重要。
