Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Singapore Med J. 2010 Nov;51(11):848-52.
This study aimed to examine the epidemiology and outcome of subglottic stenosis in infants and children, and to evaluate the current techniques used in its diagnosis and management at the KK Women's and Children's Hospital, Singapore.
A retrospective review and long-term follow-up was conducted in all infants and children diagnosed with subglottic stenosis between January 1997 and December 2008.
A total of 18 patients (nine male and nine female) with a median age of 7.5 months were identified. Two patients were diagnosed with definite congenital stenosis and 16 patients with acquired stenosis. The majority had Grade I stenosis (55.6 percent), followed by Grade II (27.8 percent) and Grade III (16.7 percent). None had Grade IV stenosis. 17 patients were intubated, and seven underwent tracheostomy. The most common surgical intervention performed was microlaryngoscopy and bronchoscopy with bougie dilation. The other surgical interventions included cricoid split, laryngotracheal reconstruction and cricotracheal resection. As of December 2008, the median duration of treatment was four years, with an overall recovery rate of 66.7 percent. The successful decannulation rate was 57.1 percent. Two mortalities were reported due to reasons unrelated to subglottic stenosis. Two patients were still undergoing treatment at the time of the study, and two were lost to follow-up.
Conservative management alone may be required in the majority of Grade I stenosis cases. We observed that the mean number of reconstructive procedures performed per patient increased with the increase in the severity of stenosis. Each laryngeal framework procedure has to be customised to suit the individual.
本研究旨在探讨婴幼儿声门下狭窄的流行病学和结局，并评估新加坡 KK 妇女儿童医院目前用于其诊断和治疗的技术。
对 1997 年 1 月至 2008 年 12 月期间诊断为声门下狭窄的所有婴儿和儿童进行回顾性分析和长期随访。
共发现 18 例（男 9 例，女 9 例）患者，中位年龄为 7.5 个月。2 例患者被诊断为明确的先天性狭窄，16 例为获得性狭窄。大多数患者为 I 级狭窄（55.6%），其次是 II 级（27.8%）和 III 级（16.7%）。无 IV 级狭窄。17 例患者插管，7 例患者行气管切开术。最常进行的手术干预是显微镜喉镜和支气管镜下探条扩张。其他手术干预包括环状软骨切开术、喉气管重建术和环状气管切除术。截至 2008 年 12 月，中位治疗时间为 4 年，总体恢复率为 66.7%。成功拔管率为 57.1%。有 2 例死亡与声门下狭窄无关。研究时，2 例患者仍在接受治疗，2 例失访。
大多数 I 级狭窄病例可能仅需要保守治疗。我们观察到，随着狭窄程度的增加，每位患者接受重建手术的平均次数也随之增加。每个喉框架手术都需要根据个体情况进行定制。
