Garabedian Erea-Noël, Nicollas Richard, Roger Gilles, Delattre Jerôme, Froehlich Patrick, Triglia Jean-Michel
Department of Pediatric Ear, Nose, and Throat, Armand-Trousseau Children's Hospital, Paris VI University, Assistance Publique-Hôpitaux de Paris, Paris, France.
Arch Otolaryngol Head Neck Surg. 2005 Jun;131(6):505-8. doi: 10.1001/archotol.131.6.505.
To review cricotracheal resection (CTR) in children weighing less than 10 kg.
Retrospective study of 17 patients (mean follow-up, 23 months) from 3 ear, nose, and throat pediatric centers.
Seventeen children (10 boys and 7 girls; mean age, 14.6 months; and mean weight, 7.6 kg) undergoing CTR from June 1995 to March 2003.
Decannulation rates and endoscopies.
The cause was congenital subglottic stenosis in 2 children (12%) and acquired subglottic stenosis in 15 (88%). All but 1 had grade 3 or 4 stenosis. The mean hospitalization duration was 34 days. Single-stage CTR was performed in 11 children (65%), with peroperative decannulation in 7. Extubation of these patients occurred between days 3 and 9. Decannulation of the other 6 patients was performed after a median of 15 days. Sixteen (94%) of the 17 children were decannulated. Four patients required additional carbon dioxide laser treatment for subsequent glottic or subglottic edema or granulomas, but no reintubation was necessary. One child could not be decannulated because of bronchopulmonary disease, and subglottic stenosis recurred. Long-term tracheotomy was avoided in all other patients. Another child died of cardiac disease. All other patients remained free of significant subglottic stenosis at follow-up.
Cricotracheal resection in small children weighing less than 10 kg was a safe and effective procedure for severe subglottic stenosis. To our knowledge, this is the first reported attempt of CTR in this weight category, providing results comparable to those published in older children.
回顾体重小于10kg儿童的环状气管切除术（CTR）。
对来自3个儿科耳鼻喉中心的17例患者（平均随访23个月）进行回顾性研究。
1995年6月至2003年3月期间接受CTR的17例儿童（10例男孩和7例女孩；平均年龄14.6个月；平均体重7.6kg）。
拔管率和内镜检查。
病因是先天性声门下狭窄2例（12%），后天性声门下狭窄15例（88%）。除1例患者外，其余均为3级或4级狭窄。平均住院时间为34天。11例儿童（65%）接受了一期CTR，其中7例术中拔管。这些患者在术后第3至9天拔管。另外6例患者在中位数为15天后拔管。17例儿童中有16例（94%）成功拔管。4例患者因随后出现声门或声门下水肿或肉芽肿需要额外的二氧化碳激光治疗，但无需再次插管。1例儿童因支气管肺疾病未能拔管，声门下狭窄复发。所有其他患者均避免了长期气管切开。另1例儿童死于心脏病。所有其他患者在随访时均未出现明显的声门下狭窄。
对于严重的声门下狭窄，体重小于10kg的小儿进行环状气管切除术是一种安全有效的手术。据我们所知，这是首次报道在该体重范围内尝试CTR，其结果与大龄儿童发表的结果相当。
