Division of Otolaryngology-Head & Neck Surgery, Department of Surgery, University of California San Diego, 200 W Arbor Dr. MC8895, San Diego, CA, 92103, USA.
UC San Diego School of Medicine, University of California San Diego, 9500 Gilman Dr., La Jolla, CA, 92093, USA.
Int J Pediatr Otorhinolaryngol. 2020 Dec;139:110405. doi: 10.1016/j.ijporl.2020.110405. Epub 2020 Sep 30.
Tracheal stenosis and tracheobronchomalacia are complicated, patient-specific diseases that can be treated with intraluminal stenting. Most commonly, silicone and metal stents are utilized, however, they pose significant early and late morbidity and are further complicated by growth of the airway in the pediatric population. Given recent improvements in materials science, there is a growing body of evidence suggesting a strong role for bioresorbable intraluminal stents in treating pediatric tracheobronchial obstruction.
A PubMed.gov literature search was performed on December 3, 2019 and May 15, 2020, and a 2-researcher systematic review was performed following the PRISMA criteria. The following search query was utilized: (((((((bioresorbable) OR bioabsorbable) OR resorbable) OR absorbable) OR biodegradable AND airway) OR trachea) AND stent. A pooled statistical analysis was performed on all reported pediatric patients using SPSS software.
1369 publications were screened and 26 articles with original data were identified. Materials used included polydioxanone (PDO), poly-l-lactic acid (PLLA), polyglycolic acid/poly-l-lactide co-polymer with Proglactin 910 (Vicryl®-PDS®), polycaprolactone (PCL), magnesium alloys, and co-polymers in varying proportions. Twelve articles presented data on human subjects, 8 of which were case series and case reports on pediatric populations using polydioxanone (PDO) stents. Pooled statistical analysis demonstrated an average age of 19 months (range 0.25-144), 56.5% associated with a cardiovascular anomaly, and overall complication rate of 21.7%, with a stent fragment foreign body being the most common (8.7%), followed by significant granulation tissue (4.3%), stent migration (4.3%), and local stenosis (4.3%). Comparative analysis demonstrated short-term improvement (up to 1 month) has a statistically significant association with tracheobronchomalacia versus tracheal stenosis on chi-squared test (p = 0.001). The remaining analyses did not yield statistical significance.
The reported application of bioresorbable materials as intraluminal airway stents is positive. All comparative animal studies report biocompatibility and fewer morbidities compared to metal and silicone stents, however, in human studies there are concerns over the short interval of degradation and the potential for obstructive foreign bodies in poorly seated stents. Overall, there are clear, reproducible advantages to bioresorbable intraluminal stents in pediatric airway obstruction, as well as common pitfalls, that warrant further research.
气管狭窄和气管支气管软化是复杂的、针对特定患者的疾病，可以通过腔内支架治疗。最常用的是硅酮和金属支架，但它们会导致严重的早期和晚期发病率，并进一步复杂化，因为在儿科人群中气道会生长。鉴于材料科学的最新进展，越来越多的证据表明生物可吸收腔内支架在治疗小儿气管支气管阻塞方面具有重要作用。
我们于 2019 年 12 月 3 日和 2020 年 5 月 15 日在 PubMed.gov 上进行了文献检索，并按照 PRISMA 标准进行了 2 位研究人员的系统评价。使用了以下搜索查询：((((((((生物可吸收)或可吸收)或可吸收)或可吸收)或可生物降解和气道)或气管)和支架。使用 SPSS 软件对所有报告的儿科患者进行了汇总统计分析。
筛选出 1369 篇文献，确定了 26 篇具有原始数据的文章。使用的材料包括聚二氧杂环已酮（PDO）、聚 L-乳酸（PLLA）、聚乙二醇酸/聚 L-乳酸共聚物与 Proglactin 910（Vicryl®-PDS®）、聚己内酯（PCL）、镁合金和不同比例的共聚物。有 12 篇文章介绍了人类受试者的数据，其中 8 篇是关于使用聚二氧杂环已酮（PDO）支架的儿科人群的病例系列和病例报告。汇总统计分析显示，平均年龄为 19 个月（范围 0.25-144），56.5%与心血管异常有关，总并发症发生率为 21.7%，支架碎片异物最常见（8.7%），其次是明显的肉芽组织（4.3%）、支架迁移（4.3%）和局部狭窄（4.3%）。比较分析表明，在卡方检验中，短期（最长 1 个月）改善与气管支气管软化（p=0.001）有统计学意义。其余分析未得出统计学意义。
生物可吸收材料作为腔内气道支架的应用报告是积极的。所有比较动物研究都报告说，与金属和硅酮支架相比，生物可吸收材料具有更好的生物相容性和更少的发病率，但在人体研究中，人们担心支架降解时间短和支架位置不当导致阻塞性异物的潜在风险。总的来说，生物可吸收腔内支架在小儿气道阻塞方面具有明确的、可重复的优势，同时也存在常见的缺陷，这需要进一步的研究。
