Wu Derek, Virbalas Jordan, Lee Andrew, Bent John
SUNY Downstate Medical Center, Department of Otolaryngology- Head and Neck Surgery, SUNY Downstate Medical Center, 450 Clarkson Avenue, Box 126, Brooklyn, NY, 11203, USA.
Department of Otolaryngology-Head and Neck Surgery, University of California, San Francisco, 2233 Post Street, Rm 357, San Francisco, CA, 94115, USA.
Int J Pediatr Otorhinolaryngol. 2018 Aug;111:93-96. doi: 10.1016/j.ijporl.2018.05.025. Epub 2018 May 29.
INTRODUCTION/OBJECTIVE: In laryngotracheal reconstruction (LTR) with sutureless posterior cricoid grafting (PCG), the inset graft's thickness may not precisely approximate the anterior-posterior depth of the divided posterior cricoid plate. This case series highlights this phenomenon and describes the clinical profiles and airway characteristics of children with similar subglottic stenosis grades undergoing LTR with PCG with varying degrees of graft-cricoid mismatch.
This is a case series with retrospective chart review of children who underwent LTR with PCG by a single surgeon at a tertiary care urban children's hospital from 2008 to 2014.
Twenty-one patients with twenty-two operations were identified. Varying degrees of graft-cricoid mismatch were present. Of the 22 operations, 15 were classified as grade I (flush), 5 grade II (<3 mm), and 2 grade III (>3 mm). Median preoperative grade of stenosis was III in all groups. Mean one month granulation grade was 1.84, compared to 1.92 in grade I, 1.6 in grade II mismatch, 2 in grade III mismatch, and 1.7 in any mismatch (p = 0.65). Mean follow up was 24 months.
Graft-cricoid mismatch may occur at variable degrees during laryngotracheal reconstruction utilizing sutureless posterior cricoid grafting. Our preliminary data suggest several millimeters of graft-cricoid mismatch can be tolerated without significantly affecting postoperative granulation formation or adding to postoperative morbidity.
引言/目的：在采用无缝合后环状软骨移植（PCG）的喉气管重建（LTR）中，植入移植物的厚度可能无法精确匹配切开的后环状软骨板的前后深度。本病例系列突出了这一现象，并描述了接受不同程度移植物与环状软骨不匹配的PCG喉气管重建的声门下狭窄程度相似的儿童的临床特征和气道特征。
这是一个病例系列，对2008年至2014年在一家城市三级儿童医院由一名外科医生进行PCG喉气管重建的儿童进行回顾性病历审查。
确定了21例患者，共进行了22次手术。存在不同程度的移植物与环状软骨不匹配。在这22次手术中，15次被归类为I级（平齐），5次为II级（<3毫米），2次为III级（>3毫米）。所有组术前狭窄的中位分级均为III级。术后1个月平均肉芽分级为1.84，I级为1.92，II级不匹配为1.6，III级不匹配为2，任何不匹配情况为1.7（p = 0.65）。平均随访时间为24个月。
在采用无缝合后环状软骨移植的喉气管重建过程中，移植物与环状软骨不匹配可能会以不同程度出现。我们的初步数据表明，几毫米的移植物与环状软骨不匹配可以被耐受，而不会显著影响术后肉芽形成或增加术后发病率。
