Liew Y T, Yong D J, Somasundran M, Lum C L
Otorhinolaryngology Department, Queen Elizabeth Hospital, 88300 Kota Kinabalu, Sabah Malaysia.
Indian J Otolaryngol Head Neck Surg. 2015 Mar;67(Suppl 1):129-33. doi: 10.1007/s12070-014-0801-8. Epub 2014 Nov 19.
The aim of the study was to examine and analyze the epidemiology and outcome of treatment for paediatric acquired subglottic stenosis treated with endoscopic bougie dilatation and topical mitomycin C. There were 15 patients identified from 2008 until 2013. All of them had acquired subglottic stenosis due to history of intubation. Majority of the patients had grade III stenosis, with the total of seven. Three patients had grade IV; three were grade II and two were grade I. All of the patients with severe stenosis (grade III and IV) needed tracheostomy while only one in mild stenosis group (grade I and II) required it for prolonged ventilation rather than obstruction due to subglottic stenosis. All of them underwent direct laryngoscopy under general anesthesia followed by endoscopic dilatation with bougie and topical mitomycin C 0.4 mg/ml for 5 min. Aim of success in our study was decannulation of tracheostomy or absence of symptoms at exertion. We achieved 6 (60 %) successful decannulation out of 10 patients with tracheostomy (excluded the patient with tracheostomy in grade I stenosis due to prolonged ventilation). As for those without tracheostomy, 3 (75 %) out of 4 patients were asymptomatic even at exertion. Average number of dilatation was 3.1 times, with mean duration of 28 min. No complications were reported in our series. One patient with grade I stenosis passed away due to severe pneumonia unrelated to the stenosis or dilatation, and she did not have any dilatation before she passed away. Multiple related risk factors were identified such as intubation, prematurity, movement of endotracheal tube, respiratory infection, traumatic intubation and gastroesophageal reflux disease. Experience of open surgical method was very limited in our centre in Sabah in East Malaysia. Endoscopic technique plays an important role in treatment of subglottic stenosis with adjunct like mitomycin C possibly booster the successful rate.
本研究旨在探讨和分析采用内镜探条扩张联合局部应用丝裂霉素C治疗小儿获得性声门下狭窄的流行病学情况及治疗效果。2008年至2013年共确定了15例患者。他们均因插管史而患有获得性声门下狭窄。大多数患者为III级狭窄，共7例。3例为IV级；3例为II级，2例为I级。所有重度狭窄（III级和IV级）患者均需要气管切开术，而轻度狭窄组（I级和II级）中只有1例因需要长时间通气而非声门下狭窄导致的梗阻而需要气管切开术。所有患者均在全身麻醉下接受直接喉镜检查，随后用探条进行内镜扩张，并局部应用0.4mg/ml丝裂霉素C 5分钟。本研究的成功目标是气管切开术拔管或运动时无症状。在10例接受气管切开术的患者中（不包括因长时间通气导致I级狭窄而行气管切开术的患者），我们实现了6例（60%）成功拔管。对于那些未行气管切开术的患者，4例中有3例（75%）即使在运动时也无症状。平均扩张次数为3.1次，平均持续时间为28分钟。我们的系列研究中未报告并发症。1例I级狭窄患者因与狭窄或扩张无关的严重肺炎去世，她在去世前未进行任何扩张。确定了多个相关危险因素，如插管、早产、气管内导管移动、呼吸道感染、创伤性插管和胃食管反流病。在马来西亚东部沙巴的我们中心，开放手术方法的经验非常有限。内镜技术在声门下狭窄的治疗中发挥着重要作用，联合应用丝裂霉素C等辅助药物可能会提高成功率。
Zotero 插件