Chiang Tendy, McConnell Brook, Ruiz Amanda G, DeBoer Emily M, Prager Jeremy D
Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Colorado Springs, CO, USA.
Department of Otolaryngology, University of Colorado School of Medicine, Aurora, CO, USA; Department of Pediatric Otolaryngology, Children's Hospital Colorado, Aurora, CO, USA.
Int J Pediatr Otorhinolaryngol. 2014 Dec;78(12):2244-9. doi: 10.1016/j.ijporl.2014.10.023. Epub 2014 Oct 25.
Laryngeal clefts (LC) are congenital malformations of the upper aerodigestive tract that can cause dysphagia, aspiration, and subsequent pulmonary complications. This investigation assessed the outcomes of multidisciplinary evaluation and surgical management of type I and II LC (LC1-2) at a tertiary children's hospital.
A retrospective chart review was used to identify patients who underwent repair of LC1-2 by a single surgeon.
Twenty-five patients who underwent surgical management for LC1-2 were identified. Twenty patients with LC-1 and 5 with LC-2 were included. Most common presentations were aspiration on modified barium swallow (MBS) (76%) and recurrent pulmonary infections (60%). Gastroesophageal reflux disease (GERD) was a concurrent co-morbidity in 68%. Of the 19 patients who presented with preoperative aspiration on MBS, 52.6% had evidence of improvement on their first MBS. This improved to 78.9% at the time of their most recent MBS (10 with resolution of aspiration, 5 with improved tolerance of consistencies). Two patients failed to improve from surgical repair and two had worsened aspiration on most recent MBS.
Endoscopic repair of laryngeal clefts is a well-tolerated procedure. Concurrent GERD and positive bronchoalveolar lavage (BAL) cultures are common and require management prior to definitive repair. Given the multidimensional nature of swallowing disorders and aspiration, a comprehensive team approach in the evaluation, management, and surveillance of these patients is a valuable complement to surgical repair since not all aspiration may resolve.
喉裂（LC）是上消化道气道的先天性畸形，可导致吞咽困难、误吸及随后的肺部并发症。本研究评估了一家三级儿童医院对I型和II型喉裂（LC1 - 2）进行多学科评估和手术治疗的结果。
采用回顾性病历审查来确定由单一外科医生进行LC1 - 2修复的患者。
确定了25例接受LC1 - 2手术治疗的患者。其中包括20例LC - 1患者和5例LC - 2患者。最常见的表现为改良钡餐吞咽检查（MBS）时出现误吸（76%）和反复肺部感染（60%）。68%的患者同时合并胃食管反流病（GERD）。在19例术前MBS检查出现误吸的患者中，52.6%的患者在首次MBS检查时有改善迹象。在最近一次MBS检查时，这一比例提高到了78.9%（10例误吸消失，5例对食物稠度的耐受性提高）。2例患者手术修复后未改善，2例在最近一次MBS检查时误吸加重。
喉裂的内镜修复是一种耐受性良好的手术。同时合并GERD和支气管肺泡灌洗（BAL）培养阳性很常见，在进行确定性修复之前需要进行处理。鉴于吞咽障碍和误吸的多维度性质，对这些患者进行评估、管理和监测时采用综合团队方法是手术修复的重要补充，因为并非所有误吸都能解决。
