特发性声门下狭窄的多模态治疗方法的结果。
Outcome of a multimodality approach to the management of idiopathic subglottic stenosis.
机构信息
National Centre for Airway Reconstruction, Department of Otolaryngology, Charing Cross Hospital, London, United Kingdom.
出版信息
Laryngoscope. 2013 Oct;123(10):2474-84. doi: 10.1002/lary.23949. Epub 2013 Aug 5.
OBJECTIVES/HYPOTHESIS: To assess the results of treating idiopathic subglottic stenosis (ISS), determine predictors of treatment success and outcome, and better define roles and limitations of endoscopic and open surgery.
STUDY DESIGN
Prospective observational study.
METHODS
Fifty-four consecutive patients were treated between 2004 and 2012. Patient, stenosis and treatment details, complications, open surgery rates, and outcomes were recorded. Regression analyses were used to identify predictors of endoscopic treatment success; treatment frequency; and functional outcomes in airway, dyspnea, voice, and swallowing domains.
RESULTS
All patients were female and mean age at diagnosis was 48 ± 12 years. Symptoms-to-diagnosis latency was 21 ± 20 months. There were 10 concomitant glottic and subglottic stenoses. Most lesions were Myer-Cotton grade 3 (48%). Overall, 78% of patients were managed endoscopically. Treatment included intralesional corticosteroids, laser surgery, balloon dilation, and temporary silastic stenting in selected cases. Annual intervention rate was 1.07 ± 0.79. Mean follow-up was 45 months. Factors associated with intervention frequency were stenosis location and severity. Twelve patients underwent anteroposterior laryngotracheal reconstruction with biological inhibition. This resulted in disease remission in all patients with subglottic stenosis, and in most patients with concomitant glottic and subglottic stenosis. Patients with total laryngotracheal stenosis required ongoing treatment for glottic disease. All patients maintained prosthesis-free airways, but in one patient this required a laryngectomy. Most patients achieved good functional outcomes. Stenosis location was the only independent predictor of dyspnea and voice outcomes.
CONCLUSIONS
ISS can be effectively treated with endoscopic surgery or a bespoke open reconstructive procedure that does not compromise on female voice quality.
LEVEL OF EVIDENCE
目的/假设：评估特发性声门下狭窄（ISS）的治疗结果，确定治疗成功和结果的预测因素，并更好地定义内镜和开放手术的作用和局限性。
研究设计
前瞻性观察研究。
方法
2004 年至 2012 年期间，连续治疗了 54 例患者。记录患者、狭窄和治疗细节、并发症、开放手术率和结局。回归分析用于确定内镜治疗成功的预测因素；治疗频率；以及气道、呼吸困难、声音和吞咽领域的功能结局。
结果
所有患者均为女性，诊断时的平均年龄为 48±12 岁。症状至诊断的潜伏期为 21±20 个月。有 10 例同时存在声门和声门下狭窄。大多数病变为迈尔-科顿 3 级（48%）。总体而言，78%的患者接受了内镜治疗。治疗包括病灶内皮质类固醇、激光手术、球囊扩张和在选择的情况下临时硅酮支架置入。年干预率为 1.07±0.79。平均随访时间为 45 个月。与干预频率相关的因素包括狭窄位置和严重程度。12 例患者接受了前后径路喉气管重建术，采用生物抑制。这导致所有声门下狭窄患者的疾病缓解，以及大多数同时存在声门和声门下狭窄患者的疾病缓解。全喉气管狭窄患者需要继续治疗声门疾病。所有患者均保持无假体气道，但有 1 例患者需要行喉切除术。大多数患者获得了良好的功能结局。狭窄位置是呼吸困难和声音结局的唯一独立预测因素。
结论
ISS 可以通过内镜手术或定制的开放重建手术有效治疗，而不会影响女性的声音质量。
证据水平
4 级。
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