Fiz Ivana, Monnier Philippe, Koelmel Jan Constantin, Di Dio Diana, Torre Michele, Fiz Francesco, Missale Francesco, Piazza Cesare, Peretti Giorgio, Sittel Christian
Department of Otorhinolaryngology Head and Neck Surgery, Katharinenhospital, Kriegsbergstrasse 60, 70174, Stuttgart, Germany.
Airway Unit, Service of Otorhinolaryngology, Lausanne University Hospital, Lausanne, Switzerland.
Eur Arch Otorhinolaryngol. 2019 Mar;276(3):785-792. doi: 10.1007/s00405-019-05353-4. Epub 2019 Feb 22.
The European Laryngological Society (ELS) has published a revised classification for benign laryngotracheal stenosis (LTS), based on their degree, longitudinal extension, and associated comorbidities. We retrospectively applied this classification to pediatric patients treated in four referral centers to assess its reliability in predicting surgical outcomes.
We included 191 pediatric LTS patients treated by segmental resection, restaged according to the degree of stenosis (I-IV according to Myer-Cotton grading system), number of subsites involved ("a" to "d" for 1-4 subsites among supraglottis, glottis, subglottis and trachea), and presence of systemic comorbidity ("+" sign). We analyzed the ability of this scoring system in predicting the rates of decannulation and complications, as well as the number of re-treatments.
The mean decannulation rate was 88%; a higher rate was observed in patients without comorbidities (95.7% vs. 78.1%, p < 0.001), with two or fewer vs. three or four subsites involved (89% vs. 72%, p < 0.01), and in those with an ELS score of IIIa+ or less vs. patients with IIIb or more (96% vs. 82%, p < 0.001). Surgical complications were not dependent on the degree of stenosis, but rather on the number of affected subsites (p < 0.05), as well as on the presence of associated comorbidities (RR 7.5, p < 0.01). The number of re-treatments was dependent on length of resection (p < 0.05), stage according to the revised ELS classification (p < 0.001), and presence of surgical complications (RR 17, p < 0.001).
The revised ELS classification system is easy to apply in everyday practice and offers a sound contribution in the decision-making process.
欧洲喉科学会（ELS）基于良性喉气管狭窄（LTS）的程度、纵向延伸范围及相关合并症发布了修订分类。我们对在四个转诊中心接受治疗的儿科患者进行回顾性应用该分类，以评估其预测手术结果的可靠性。
我们纳入了191例接受节段性切除治疗的儿科LTS患者，根据狭窄程度（按照迈尔 - 科顿分级系统分为I - IV级）、受累亚部位数量（声门上、声门、声门下和气管中1 - 4个亚部位分别用“a”至“d”表示）以及全身合并症情况（“+”号表示）重新分期。我们分析了该评分系统预测拔管率和并发症发生率以及再次治疗次数的能力。
平均拔管率为88%；无合并症患者的拔管率更高（95.7%对78.1%，p < 0.001），受累亚部位为两个或更少对三个或四个的患者中拔管率更高（89%对72%，p < 0.01），ELS评分为IIIa +或更低的患者比评分为IIIb或更高的患者拔管率更高（96%对82%，p < 0.001）。手术并发症不取决于狭窄程度，而是取决于受累亚部位数量（p < 0.05）以及合并症的存在情况（相对危险度7.5，p < 0.01）。再次治疗次数取决于切除长度（p < 0.05）、根据修订后的ELS分类的分期（p < 0.001）以及手术并发症的存在情况（相对危险度17，p < 0.001）。
修订后的ELS分类系统易于在日常实践中应用，并在决策过程中提供了有力帮助。
