Whigham Amy S, Howell Rebecca, Choi Sukgi, Peña Maria, Zalzal George, Preciado Diego
Division of Otolaryngology, Children's National Medical Center, George Washington University School of Medicine, Washington, DC 20010, USA.
Ann Otol Rhinol Laryngol. 2012 Jul;121(7):442-8. doi: 10.1177/000348941212100704.
We report outcomes of balloon dilation in the endoscopic management of pediatric subglottic stenosis (SGS) and discuss the role of balloon dilation in both primary and adjuvant therapy.
We performed a retrospective review of treatment with noncompliant, high-pressure balloons for SGS in the past 2 years at a tertiary pediatric hospital. Fifty-one dilations were performed in 28 children with SGS. The children's mean age was 42 months. The mean SGS grade was 2.46.
Fifteen children had primary balloon dilation, and 13 had adjuvant balloon dilation. Overall, 16 children (57.1%) had successful balloon dilation. Of those who underwent primary dilation, 9 (60.0%) were able to avoid open reconstruction or tracheotomy and 6 had their symptoms temporarily improved (average, 36 days) until definitive open reconstruction. Of the patients who underwent adjuvant dilation, 7 (53.8%) were successfully decannulated. Nine of the 12 failed balloon dilations were in children who had concomitant airway disorders; in contrast, only 6 of 16 children in whom treatment was successful had concomitant airway disorders (p = 0.048). There was no statistical association between successful versus failed treatment and age (51.6 versus 27.9 months; p = 0.23), degree of stenosis (grade 2.3 versus grade 2.6; p = 0.41), presence of lung disease (33.3% versus 70%; p = 0.07), or soft versus firm stenosis (60.0% versus 53.1%; p = 0.71).
Balloon dilation plays an important role in the primary and adjuvant management of pediatric SGS. The presence of concomitant airway lesions is significantly associated with failure of balloon dilation treatment. Meticulous surveillance of the dilated airway is necessary, given this failure rate.
我们报告了球囊扩张术在小儿声门下狭窄（SGS）内镜治疗中的结果，并讨论球囊扩张术在原发性和辅助治疗中的作用。
我们对一家三级儿童医院过去2年中使用非顺应性高压球囊治疗SGS的情况进行了回顾性研究。对28例SGS患儿进行了51次扩张。患儿的平均年龄为42个月。平均SGS分级为2.46。
15例患儿接受了原发性球囊扩张，13例接受了辅助性球囊扩张。总体而言，16例患儿（57.1%）球囊扩张成功。在接受原发性扩张的患儿中，9例（60.0%）能够避免开放性重建或气管切开术，6例症状暂时改善（平均36天），直至进行确定性开放性重建。在接受辅助性扩张的患者中，7例（53.8%）成功拔管。12例球囊扩张失败的患儿中有9例伴有气道疾病；相比之下，治疗成功的16例患儿中只有6例伴有气道疾病（p = 0.048）。治疗成功与失败与年龄（51.6个月对27.9个月；p = 0.23）、狭窄程度（2.3级对2.6级；p = 0.41）、肺部疾病的存在（33.3%对70%；p = 0.07）或软性与硬性狭窄（60.
