Hoff Stephen R, Schroeder James W, Rastatter Jeff C, Holinger Lauren D
Department of Otolaryngology-Head and Neck Surgery, University of Illinois Medical Center at Chicago, Chicago, IL, USA.
Int J Pediatr Otorhinolaryngol. 2010 Mar;74(3):245-9. doi: 10.1016/j.ijporl.2009.11.012. Epub 2009 Dec 21.
To determine if age and comorbid conditions effect outcomes in children undergoing supraglottoplasty for severe laryngomalacia.
Retrospective study.
Urban tertiary-care children's hospital.
Children undergoing supraglottoplasty for severe laryngomalacia between February 2004 and July 2008. 56 patients were identified.
Persistence of upper airway obstruction, revision surgery (supraglottoplasty), and additional surgery (tracheostomy).
33/56 (58.9%) patients had no comorbid conditions and 23/56 (41.1%) patients had comorbid conditions. In noncomorbid patients, 36.4% of those less than 2 months of age at the time of surgery required revision supraglottoplasty, compared to 5.3% of patients between 2 and 10 months (p<0.05). Compared to the 2-10-month age group, there was a significantly higher percentage of patients with comorbid conditions in the >10-month group (32.1% vs. 79%, p<0.01). Patients with comorbid conditions were diagnosed at a significantly later age than those without (6 mo vs. 2 mo, respectively), and had significantly higher rates of revision supraglottoplasty (47.8% vs. 18.2%) and tracheostomy (39.1% vs. 0.0%). 70% of children with neurological conditions required revision surgery, with 60% requiring tracheostomy. The revision surgery and tracheostomy rates were significantly higher compared to the noncomorbid group (p<0.01 and p<0.0001). Children with cardiac conditions had a higher rate of tracheostomy than noncomorbid children (30% vs. 0%, p<0.01). 16.7% of children with genetic conditions required supraglottoplasty, and none required tracheostomy.
In noncomorbid patients, those undergoing supraglottoplasty less than 2 months of age had a significantly higher rate of revision supraglottoplasty. Patients with neurologic and cardiac comorbidities require tracheostomy at a significantly higher rate than noncomorbid patients.
确定年龄和合并症是否影响重度喉软化症患儿行声门上成形术的预后。
回顾性研究。
城市三级儿童医院。
2004年2月至2008年7月期间因重度喉软化症行声门上成形术的患儿。共纳入56例患者。
上气道梗阻持续存在情况、翻修手术（声门上成形术）及额外手术（气管切开术）。
56例患者中，33例（58.9%）无合并症，23例（41.1%）有合并症。在无合并症的患者中，手术时年龄小于2个月的患者中有36.4%需要行声门上成形术翻修，而2至10个月的患者中这一比例为5.3%（p<0.05）。与2至10个月年龄组相比，大于10个月组中有合并症的患者比例显著更高（32.1%对79%，p<0.01）。有合并症的患者确诊年龄显著晚于无合并症的患者（分别为6个月和2个月），且声门上成形术翻修率（47.8%对18.2%）和气管切开率（39.1%对0.0%）显著更高。70%患有神经系统疾病的患儿需要翻修手术，其中60%需要气管切开术。与无合并症组相比，翻修手术率和气管切开率显著更高（p<0.01和p<0.0001）。患有心脏疾病的患儿气管切开率高于无合并症患儿（30%对0%，p<0.01）。16.7%患有遗传性疾病的患儿需要行声门上成形术，且均无需气管切开术。
在无合并症的患者中，手术时年龄小于2个月而行声门上成形术的患者声门上成形术翻修率显著更高。患有神经和心脏合并症的患者气管切开率显著高于无合并症的患者。
