Hartnick C J, Hartley B E, Lacy P D, Liu J, Willging J P, Myer C M, Cotton R T
Department of Pediatric Otolaryngology, Children's Hospital Medical Center, Cincinnati, Ohio, USA.
Ann Otol Rhinol Laryngol. 2001 Dec;110(12):1109-13. doi: 10.1177/000348940111001204.
To set the foundation to develop a disease-based, operation-specific model to predict the outcome of pediatric airway reconstruction surgery, we performed a retrospective database review of children operated on at a single, tertiary-care children's hospital. Over the 12-year period 1988 to 2000, a total of 1,296 airway reconstruction procedures were performed. Out of these, charts were identified for 199 children who underwent laryngotracheal reconstruction for a sole diagnosis of subglottic stenosis. Children were excluded from the study if their disorder included supraglottic, glottic, or upper tracheal disease. The main outcome measures were Myer-Cotton grade-specific decannulation and extubation rates, including both operation-specific and overall results. There were 101 children who underwent double-stage laryngotracheal reconstruction. The operation-specific decannulation rates for Myer-Cotton grades 2, 3, and 4 were 85% (18/21), 37% (23/61), and 50% (7/14) (chi2 analysis, p = .0007). The overall decannulation rates were 95% (20/21), 74% (45/61), and 86% (12/14) (chi2 analysis, p = .04). There were 98 children who underwent single-stage laryngotracheal reconstruction. The operation-specific extubation rates for Myer-Cotton grades 2, 3, and 4 were 82% (37/45), 79% (34/43), and 67% (2/3) (chi2 analysis, p = .63). The overall extubation rates were 100% (45/45), 86% (37/43), and 100% (3/3) (chi2 analysis, p = .03). Logistic regression analysis showed no effect of age (less than or greater than 2 years of age) on operation-specific or overall outcome parameters. We conclude that laryngotracheal reconstruction for pediatric subglottic stenosis remains a challenging set of procedures in which multiple operations may be required to achieve eventual extubation or decannulation. Children with Myer-Cotton grade 3 or 4 disease continue to represent a significant challenge, and refinements of techniques are being examined to address this subset of children. Disease-based, operation-specific outcome statistics are the first step in the development of a meaningful predictive model.
为建立一个基于疾病、针对特定手术的模型来预测小儿气道重建手术的结果，我们对一家三级儿童专科医院接受手术的儿童进行了回顾性数据库审查。在1988年至2000年的12年期间，共进行了1296例气道重建手术。其中，确定了199例因单纯声门下狭窄而接受喉气管重建的儿童病历。如果儿童的疾病包括声门上、声门或气管上段疾病，则将其排除在研究之外。主要结局指标是迈耶 - 科顿分级特异性拔管和脱管率，包括特定手术和总体结果。有101例儿童接受了两阶段喉气管重建。迈耶 - 科顿2级、3级和4级的特定手术脱管率分别为85%（18/21）、37%（23/61）和50%（7/14）（卡方分析，p = 0.0007）。总体脱管率分别为95%（20/21）、74%（45/61）和86%（12/14）（卡方分析，p = 0.04）。有98例儿童接受了单阶段喉气管重建。迈耶 - 科顿2级、3级和4级的特定手术拔管率分别为82%（37/45）、79%（34/43）和67%（2/3）（卡方分析，p = 0.63）。总体拔管率分别为100%（45/45）、86%（37/43）和100%（3/3）（卡方分析，p = 0.03）。逻辑回归分析显示年龄（小于或大于2岁）对特定手术或总体结局参数无影响。我们得出结论，小儿声门下狭窄的喉气管重建仍然是一组具有挑战性的手术，可能需要多次手术才能最终实现拔管或脱管。迈耶 - 科顿3级或4级疾病的儿童仍然是一个重大挑战，目前正在研究改进技术以应对这部分儿童。基于疾病、针对特定手术的结局统计是建立有意义的预测模型的第一步。
