de Alarcón Alessandro, Osborn Alexander J, Tabangin Meredith E, Cohen Aliza P, Hart Catherine K, Cotton Robin T, Rutter Michael J
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio2Aerodigestive and Sleep Center, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio3Department of Otolaryngology-Head a.
Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
JAMA Otolaryngol Head Neck Surg. 2015 Sep;141(9):828-33. doi: 10.1001/jamaoto.2015.1419.
This study provides clinicians with relevant information regarding the surgical outcomes of patients with laryngotracheal cleft in the context of additional airway anomalies.
To determine the rates of surgical success in patients who underwent laryngotracheal cleft repair in the context of additional airway anomalies, determine the revision rate for cleft repair, characterize the time to revision among patients who underwent cleft repair, and assess the functional swallowing outcomes after cleft repair.
DESIGN, SETTING, AND PARTICIPANTS: A retrospective study was conducted at a quaternary pediatric center of 81 children diagnosed as having laryngotracheal cleft with or without concomitant airway anomalies who underwent laryngotracheal cleft repair between February 1, 2000, and February 28, 2013. Analysis was conducted from October 1, 2012, through March 30, 2013.
Surgical repair of laryngotracheal cleft.
Surgery-specific success, overall surgical success, and revision rate. We defined surgery-specific success as a repair not requiring revision and overall surgical success as absence of a cleft or TEF at the last operative examination, regardless of the number of revisions required.
Of 81 patients with laryngotracheal cleft who underwent surgical repair, 48 (59%) had at least 1 additional airway finding; 24 (30%) had tracheomalacia and 21 (26%) had subglottic stenosis. Seventeen patients required a revision of laryngotracheal cleft repair, with a median time to revision of 8.3 months (interquartile range, 4.3-25.1 months). Six patients required a second revision, with a median interval between revisions of 44.2 months (interquartile range, 28.6-53.6 months). The surgery-specific success rate was 77% (37 of 48) in patients with additional airway anomalies and 82% (27 of 33) in those with laryngotracheal clefts alone. The overall surgical success rate was 92% (44 of 48) in patients with additional airway anomalies and 97% (32 of 33) in those with clefts alone. Fourteen (17%) patients demonstrated swallowing dysfunction postoperatively despite closure of the cleft.
Although additional airway findings were common in our cohort of patients with laryngotracheal clefts, these anomalies did not affect surgery-specific or overall surgical success. The overall surgical success rate for those with and without additional airway anomalies was 92% and 97%, respectively. In view of the fact that cleft breakdown after surgical repair is not uncommon and may occur years after the initial repair, we strongly advocate long-term follow-up. Despite successful closure, a significant percentage of children with laryngotracheal cleft will have persistent swallowing dysfunction.
本研究为临床医生提供了有关合并其他气道异常的喉气管裂患者手术结果的相关信息。
确定合并其他气道异常的情况下接受喉气管裂修复术患者的手术成功率，确定裂修复术的翻修率，描述接受裂修复术患者的翻修时间，并评估裂修复术后的吞咽功能结果。
设计、地点和参与者：在一家四级儿科中心进行了一项回顾性研究，研究对象为2000年2月1日至2013年2月28日期间接受喉气管裂修复术的81名诊断为有或无合并气道异常的儿童。分析于2012年10月1日至2013年3月30日进行。
喉气管裂的手术修复。
手术特异性成功、总体手术成功和翻修率。我们将手术特异性成功定义为无需翻修的修复，将总体手术成功定义为在最后一次手术检查时无裂或食管气管瘘，无论所需翻修次数。
在81例接受手术修复的喉气管裂患者中，48例（59%）至少有1项其他气道发现；24例（30%）有气管软化，21例（26%）有声门下狭窄。17例患者需要对喉气管裂修复术进行翻修，翻修的中位时间为8.3个月（四分位间距，4.3 - 25.1个月）。6例患者需要进行第二次翻修，两次翻修之间的中位间隔为44.2个月（四分位间距，28.6 - 53.6个月）。合并其他气道异常的患者手术特异性成功率为77%（48例中的37例），单纯喉气管裂患者为82%（33例中的27例）。合并其他气道异常的患者总体手术成功率为92%（48例中的44例），单纯裂患者为97%（33例中的32例）。14例（17%）患者尽管裂已闭合，但术后仍表现出吞咽功能障碍。
尽管在我们的喉气管裂患者队列中其他气道发现很常见，但这些异常并未影响手术特异性或总体手术成功。有和没有其他气道异常的患者总体手术成功率分别为92%和97%。鉴于手术修复后裂的裂开并不罕见，且可能在初次修复数年之后发生，我们强烈主张进行长期随访。尽管裂成功闭合，但相当比例的喉气管裂儿童仍会有持续的吞咽功能障碍。
Zotero 插件