Denoyelle Francoise, Mondain Michel, Gresillon Nicolas, Roger Gilles, Chaudre Franck, Garabedian Erea Noel
Services d'Otorhinolaryngologie Pédiatrique et de Chirurgie Cervicofaciale, Hôpital d'Enfants Armand-Trousseau, Paris, France.
Arch Otolaryngol Head Neck Surg. 2003 Oct;129(10):1077-80; discussion 1080. doi: 10.1001/archotol.129.10.1077.
To study the failures and complications of bilateral supraglottoplasty in children with severe laryngomalacia and to compare children with isolated laryngomalacia (IL) with those who have additional congenital anomalies (ACAs).
Retrospective medical record review.
Two tertiary referral centers.
A total of 136 consecutive patients, aged 3 days to 60 months (median age, 3 months) who underwent laser or instrumental bilateral supraglottoplasty. Isolated laryngomalacia occurred in 102 children, aged 3 days to 19 months; ACAs were found in 34 children, aged 3 weeks to 60 months.
Persistence of dyspnea, sleep apnea, and/or failure to thrive; need for further treatment; minor complications (defined as granuloma, edema, or small web); or major complication (supraglottic stenosis).
Failures or partial improvement were observed in 12 (8.8%) of 136 cases, all having ACAs. The overall rate of complications was 7.4% (10/136). There were no significant differences between the IL and ACA groups concerning the rate of recurrence needing revision surgery (3/102, 2.9% vs 3/34, 9%), the rate of minor complications (4/102, 3.9% vs 1/34, 3%), or the rate of supraglottic stenosis (4/102, 3.9% vs 1/34, 3%). Supraglottic stenosis was managed by revision surgery in 4 cases and/or noninvasive ventilatory assistance in 2 cases. The long-term outcome appeared to be better when reintervention could be avoided or was kept to a minimum.
Failure of supraglottoplasty was only observed in cases of laryngomalacia with ACAs. The complication rate was similar whether or not ACAs were present.
研究重度喉软化症患儿双侧声门上成形术的失败情况及并发症，并比较单纯喉软化症（IL）患儿与合并其他先天性异常（ACA）的患儿。
回顾性病历审查。
两个三级转诊中心。
共136例连续接受激光或器械双侧声门上成形术的患者，年龄3天至60个月（中位年龄3个月）。102例患儿为单纯喉软化症，年龄3天至19个月；34例患儿合并其他先天性异常，年龄3周至60个月。
呼吸困难、睡眠呼吸暂停和/或生长发育不良持续存在；是否需要进一步治疗；轻微并发症（定义为肉芽肿、水肿或小蹼）；或严重并发症（声门上狭窄）。
136例中有12例（8.8%）出现手术失败或部分改善，均合并其他先天性异常。总体并发症发生率为7.4%（10/136）。单纯喉软化症组与合并其他先天性异常组在需要再次手术的复发率（3/102，2.9%对3/34，9%）、轻微并发症发生率（4/102，3.9%对1/34，3%）或声门上狭窄发生率（4/102，3.9%对1/34，3%）方面无显著差异。4例声门上狭窄通过再次手术治疗，2例通过无创通气辅助治疗。若能避免再次干预或将其降至最低，长期预后似乎更好。
声门上成形术失败仅见于合并其他先天性异常的喉软化症病例。无论是否合并其他先天性异常，并发症发生率相似。
