多中心研究应用欧洲喉科学会成人良性喉气管狭窄分类，治疗方法为气管或环状软骨切除术和吻合术。
Multicentric study applying the european laryngological society classification of benign laryngotracheal stenosis in adults treated by tracheal or cricotracheal resection and anastomosis.
机构信息
Department of Otorhinolaryngology-Head and Neck Surgery, Stuttgart Hospital, Stuttgart, Germany.
Department of Otolaryngology-Head and Neck Surgery, University Hospital, Vaud University Hospital Center, Lausanne, Switzerland.
出版信息
Laryngoscope. 2020 Jul;130(7):1640-1645. doi: 10.1002/lary.28274. Epub 2019 Sep 11.
OBJECTIVES/HYPOTHESIS: Introduction and widespread use of cricotracheal resection and anastomosis (CTRA) as routine treatment for high-grade benign laryngotracheal stenosis (LTS) led to the need for a new classification system that could accurately predict surgical outcomes by integrating crucial stenosis and patient-related information. In 2015, the European Laryngological Society (ELS) proposed a new classification for benign LTS. We retrospectively tested it in adults treated at three referral centers to assess its reliability in predicting surgical outcomes.
STUDY DESIGN
Retrospective cohort study.
METHODS
We included 166 adults treated by open tracheal resection and anastomosis (TRA) and CTRA procedures, restaged according to the ELS classification evaluating grade of stenosis (I-IV, Myer-Cotton), number of subsites involved, and presence of systemic comorbidities. We correlated these parameters with decannulation, number of retreatments, and complications.
RESULTS
Final decannulation was predicted by a proposed ELS score ≥ IIIb, history of previous treatment, and length of resection (P < .05). Decannulation was achieved in 99% of patients without and in 88% of patients with surgical complications (P < .01). The incidence of surgical complications was related to the proposed ELS score (P < .01); an ELS score < IIIb showed a lower complication rate compared to patients with a ≥ IIIb score (32.8% vs. 57.7%, P < .01). Additional treatment was required in 73 (44%) patients (mean = 2.7 ± 2.2, range = 1-11). ELS score ≥ IIIb, length of resection, and occurrence of surgical complications predicted the number of such treatments (P < .05, P < .05, and P < .001, respectively).
CONCLUSIONS
ELS classification of benign LTS is able to accurately predict success in adult TRA/CTRA procedures and may be helpful in choice of therapy and patient counseling.
LEVEL OF EVIDENCE
2b Laryngoscope, 130:1640-1645, 2020.
目的/假设：环甲膜切除术和吻合术（CTRA）作为治疗高级别良性喉气管狭窄（LTS）的常规治疗方法的引入和广泛应用，导致需要一种新的分类系统，该系统可以通过整合关键的狭窄和患者相关信息来准确预测手术结果。2015 年，欧洲喉科学会（ELS）提出了一种良性 LTS 的新分类。我们回顾性地在三个转诊中心接受治疗的成年人中对其进行了测试，以评估其在预测手术结果方面的可靠性。
研究设计
回顾性队列研究。
方法
我们纳入了 166 例接受开放式气管切除术和吻合术（TRA）和 CTRA 治疗的成年人，根据 ELS 分类对狭窄程度（I-IV，Myer-Cotton）、受累亚区数量以及是否存在系统性合并症进行再分期。我们将这些参数与拔管、再治疗次数和并发症相关联。
结果
提出的 ELS 评分≥IIIb、既往治疗史和切除长度可预测最终拔管（P<.05）。99%的无手术并发症患者和 88%的有手术并发症患者实现了拔管（P<.01）。手术并发症的发生率与提出的 ELS 评分有关（P<.01）；ELS 评分<IIIb 的患者与评分≥IIIb 的患者相比，并发症发生率较低（32.8%比 57.7%，P<.01）。73 例（44%）患者需要额外治疗（平均=2.7±2.2，范围=1-11）。ELS 评分≥IIIb、切除长度和手术并发症的发生预测了此类治疗的次数（P<.05、P<.05 和 P<.001）。
结论
ELS 对良性 LTS 的分类能够准确预测成人 TRA/CTRA 手术的成功率，有助于选择治疗方法和患者咨询。
证据水平
2b 喉镜，130：1640-1645，2020。
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