Yamamoto Kazumichi, Jaquet Yves, Ikonomidis Christos, Monnier Philippe
Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland
Service of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Medical Center (CHUV), Lausanne, Switzerland.
Eur J Cardiothorac Surg. 2015 May;47(5):876-82. doi: 10.1093/ejcts/ezu273. Epub 2014 Jul 9.
Partial cricotracheal resection (PCTR) is widely accepted for treating severe paediatric laryngotracheal stenosis (LTS). However, it remains limited to a few experienced centres. Here we report an update of the Lausanne experience in paediatric PCTR performed or supervised by a senior surgeon (Philippe Monnier).
An ongoing database of 129 paediatric patients who underwent PCTR for benign LTS between March 1978 and July 2012 at our hospital was retrospectively reviewed. Demographic characteristics and information on preoperative status, stenosis and surgery were collected. Primary outcomes were measured as overall and operation-specific decannulation rates (ODR and OSDR, respectively), and secondary outcomes as morbidity, mortality and postoperative functional results.
A total of 129 paediatric patients [79 males and 50 females; mean age, 4.1 years (1 month-16 years, median age of 2 years old)] underwent PCTR during the study period. ODR and OSDR were 90 and 81%, respectively. The decannulation rates were significantly superior for single-stage PCTR compared with double-stage PCTR in both ODR and OSDR. Eight patients died postoperatively for reasons unrelated to surgery. Partial anastomotic dehiscence was seen in 13 patients, 9 of whom were successfully treated by revision surgery. Respiratory, voice and swallowing functions were near normal or only minimally impaired in 86, 65 and 81% of patients, respectively.
PCTR is effective and feasible with good ODR and OSDR for highgrade / severe LTS. Glottic involvement and the presence of comorbidities were negative predictive factors of decannulation. Early detection and reintervention of postoperative incipient dehiscence contribute to avoiding the progress to late restenosis; however, voice improvement remains a challenge.
部分环状气管切除术（PCTR）被广泛用于治疗严重的小儿喉气管狭窄（LTS）。然而，该手术仍仅在少数有经验的中心开展。在此，我们报告由资深外科医生（菲利普·莫尼耶）实施或指导的小儿PCTR的洛桑经验更新情况。
回顾性分析我院1978年3月至2012年7月期间129例行PCTR治疗良性LTS的小儿患者的现有数据库。收集人口统计学特征以及术前状态、狭窄情况和手术相关信息。主要结局指标为总体脱管率和手术特异性脱管率（分别为ODR和OSDR），次要结局指标为发病率、死亡率和术后功能结果。
研究期间共有129例小儿患者（79例男性和50例女性；平均年龄4.1岁[1个月至16岁，中位年龄2岁]）接受了PCTR。ODR和OSDR分别为90%和81%。在ODR和OSDR方面，单阶段PCTR的脱管率显著高于双阶段PCTR。8例患者术后因与手术无关的原因死亡。13例患者出现部分吻合口裂开，其中9例经修复手术成功治疗。分别有86%、65%和81%的患者呼吸、声音和吞咽功能接近正常或仅轻度受损。
PCTR对于重度/严重LTS有效且可行，ODR和OSDR良好。声门受累和合并症的存在是脱管的阴性预测因素。术后早期发现并干预初期裂开有助于避免进展为晚期再狭窄；然而，声音改善仍然是一个挑战。
