Wenzel Andréia Melchiors, Schweiger Cláudia, Manica Denise, Sekine Leo, Ferreira Isabel Cristina Schütz, Kuhl Gabriel, Marostica Paulo José Cauduro
Programa de Pós-Graduação em Saúde da Criança e do Adolescente, Universidade Federal do Rio Grande do Sul (UFRGS), Porto Alegre, RS, Brazil.
Otolaryngology and Head and Neck Surgery Department, Hospital de Clínicas de Porto Alegre, Porto Alegre, RS, Brazil.
Eur Arch Otorhinolaryngol. 2018 Sep;275(9):2325-2331. doi: 10.1007/s00405-018-5064-7. Epub 2018 Jul 14.
To assess the impact of balloon laryngoplasty on clinical and surgical outcomes in pediatric patients with acute subglottic stenosis.
Two case series were included and compared. The first group included patients treated initially either with tracheostomy (if severe symptoms) or with close follow-up (if mild symptoms). Those children underwent re-evaluation and specific treatment of their stenosis with laser incisions or open surgeries some weeks later. The other group included children treated initially with balloon laryngoplasty, reflecting a shift in surgical practice after 2009. Data as success of the procedure, mean hospital stay, mean pediatric intensive care unit (PICU) stay, post-procedure fever, need of antibiotics, procedure-related complications, and deaths were assessed and compared between both cohorts.
The sample comprised 38 pediatric patients aged 0-5 years. Fifteen children were treated before 2009, of who 10 (66.7%) required tracheostomy soon after the diagnosis. Ultimately, 13 (86.6%) underwent laryngotracheal reconstruction. Twenty-three children were treated after 2009 and the success rate in these patients treated primarily with balloon laryngoplasty was 82.6%. Of these, only 3 (13%) required tracheostomy and 1 (4.3%) required further open laryngotracheal reconstruction. Patients treated by balloon laryngoplasty underwent fewer procedures under general anesthesia and had a lower burden of treatment-related morbidity, as denoted by shorter PICU stay, less antibiotic use, earlier postoperative resumption of oral feeding, and a lower incidence of postoperative complications and fever.
When used for management of acute laryngeal stenosis, balloon laryngoplasty is associated with a high success rate, presenting lower morbidity than open surgery.
评估球囊喉成形术对小儿急性声门下狭窄患者临床及手术结局的影响。
纳入两个病例系列并进行比较。第一组包括最初接受气管切开术（若症状严重）或密切随访（若症状轻微）治疗的患者。这些儿童在数周后接受了狭窄的重新评估及激光切开或开放手术等特定治疗。另一组包括最初接受球囊喉成形术治疗的儿童，这反映了2009年后手术方式的转变。对两组患者的手术成功率、平均住院时间、平均儿科重症监护病房（PICU）住院时间、术后发热情况、抗生素使用需求、手术相关并发症及死亡情况等数据进行评估和比较。
样本包括38例0至5岁的儿科患者。15名儿童在2009年前接受治疗，其中10例（66.7%）在诊断后不久需要气管切开术。最终，13例（86.6%）接受了喉气管重建术。23名儿童在2009年后接受治疗，这些主要接受球囊喉成形术治疗的患者成功率为82.6%。其中，只有3例（13%）需要气管切开术，1例（4.3%）需要进一步进行开放性喉气管重建术。接受球囊喉成形术治疗的患者在全身麻醉下进行的手术较少，且治疗相关的发病率较低，表现为PICU住院时间较短、抗生素使用较少、术后更早恢复经口喂养以及术后并发症和发热的发生率较低。
当用于治疗急性喉狭窄时，球囊喉成形术成功率高，且发病率低于开放手术。
