Gustafson L M, Hartley B E, Cotton R T
Department of Otolaryngology-Head and Neck Surgery, Children's Hospital Medical Center, Cincinnati, Ohio 45267-0528, USA.
Ann Otol Rhinol Laryngol. 2001 Jan;110(1):16-9. doi: 10.1177/000348940111000103.
Pediatric acquired total subglottic stenosis (SGS) is a challenging problem. The management of these patients has evolved at our institution over the past 25 years. We conducted a retrospective study to evaluate the surgical management and outcomes of children with grade 4 SGS. Fifty-six patients have presented with acquired grade 4 SGS since 1981. The causes included previous surgery (34), prolonged intubation (15), bums (1), and unknown causes (6). Of the 56 patients, 44 (79%) were decannulated; 120 total procedures were performed, and 39 patients (70%) required more than 1 procedure for decannulation. The decannulation rate has risen from 67% in the 1980s to 86% in the 1990s. Patients who underwent cricotracheal resection (CTR) had a higher decannulation rate than patients who underwent laryngotracheal reconstruction (LTR) with anterior and posterior costal cartilage grafting (CCG) (92% versus 81%), and were less likely to need additional open procedures to achieve decannulation (18% versus 46%). The decannulation rate for children with grade 4 SGS has improved because of advances in surgical technique. Currently, the principal operations used at our institution are 1) CTR and 2) LTR with anterior and posterior CCG. There was a trend toward a higher decannulation rate in patients who underwent CTR, and they were less likely to require further reconstructive surgery before decannulation.
小儿获得性声门下狭窄（SGS）是一个具有挑战性的问题。在过去25年里，我们机构对这些患者的治疗方法不断演变。我们进行了一项回顾性研究，以评估4级SGS患儿的手术治疗及疗效。自1981年以来，共有56例患儿出现获得性4级SGS。病因包括既往手术（34例）、长时间插管（15例）、烧伤（1例）及病因不明（6例）。56例患者中，44例（79%）拔管；共进行了120次手术，39例患者（70%）需要进行1次以上手术才能拔管。拔管率从20世纪80年代的67%上升至90年代的86%。接受环状气管切除术（CTR）的患者拔管率高于接受带前后肋软骨移植（CCG）的喉气管重建术（LTR）的患者（92%对81%），且拔管时需要额外开放性手术的可能性较小（18%对46%）。由于手术技术的进步，4级SGS患儿的拔管率有所提高。目前，我们机构采用的主要手术方法有1）CTR和2）带前后CCG的LTR。接受CTR的患者拔管率有升高趋势，且拔管前需要进一步重建手术的可能性较小。
