Division of Otolaryngology, Geisinger Medical Center, Danville, Pennsylvania, U.S.A.
Division of Gastroenterology, Hepatology and Nutrition, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, U.S.A.
Laryngoscope. 2021 Jul;131(7):E2356-E2362. doi: 10.1002/lary.29338. Epub 2020 Dec 25.
OBJECTIVE/HYPOTHESIS: Determine if diagnostic findings from pre-operative multidisciplinary evaluations are associated with single surgery or overall success rates in pediatric laryngotracheal reconstruction (LTR).
Retrospective cohort.
Retrospective cohort study of patients undergoing LTR at a tertiary care children's hospital between January 01, 2008 and December 31, 2017. Success is defined as decannulation rate if tracheostomy present, and resolution of symptoms if tracheostomy not present. Cohorts compared were those who did and did not receive pulmonary and gastrointestinal preoperative testing. Multivariate, logistic regression, and Kaplan Meier analyses performed.
About 165 children were included in the study. Median age was 3 years at the time of surgery; 73% of LTRs were double-stage procedures. Single surgery and overall success rates were 75% and 87%, respectively. After adjusting for severity of stenosis and surgical approach, performing esophagogastroduodenoscopy (EGD) and normal gross appearance on EGD were associated with increased single surgery (P = .01, .005) and overall success (P = .005, .0003). Performing pH probe and normal EGD biopsy results was associated with increased overall success (P = .03, .007). Asthma and musculoskeletal comorbidities, postoperative complications, and need for postoperative balloon dilation were associated with decreased success. No other comorbidities evaluated impacted success.
Aerodigestive comorbidities are common in children undergoing LTR, and preoperative multidisciplinary workup often results in changes in management. After adjusting for grade and level of stenosis and staged approach, performing EGD and pH/impedance probe as well as normal gross and microscopic EGD findings was independently associated with increased LTR surgical success.
4 (retrospective cohort study) Laryngoscope, 131:E2356-E2362, 2021.
目的/假设：确定小儿喉气管重建术（LTR）术前多学科评估的诊断结果是否与单次手术或总体成功率相关。
回顾性队列研究。
回顾性分析 2008 年 1 月 1 日至 2017 年 12 月 31 日在一家三级儿童保健医院接受 LTR 的患者的队列研究。如果存在气管造口术，则定义为拔管率，如果不存在气管造口术，则定义为症状缓解。比较了接受和不接受肺和胃肠道术前检查的队列。进行了多变量、逻辑回归和 Kaplan-Meier 分析。
研究共纳入 165 名儿童。手术时的中位年龄为 3 岁；73%的 LTR 为双阶段手术。单次手术和总体成功率分别为 75%和 87%。在校正狭窄严重程度和手术方式后，行食管胃十二指肠镜（EGD）检查和 EGD 大体外观正常与单次手术（P=0.01，P=0.005）和总体成功率（P=0.005，P=0.0003）增加相关。行 pH 探针和正常 EGD 活检结果与总体成功率增加相关（P=0.03，P=0.007）。哮喘和肌肉骨骼合并症、术后并发症以及需要术后球囊扩张与成功率降低相关。评估的其他合并症对成功率没有影响。
在接受 LTR 的儿童中，呼吸道合并症很常见，术前多学科工作通常会导致治疗方式的改变。在校正狭窄程度和分级以及分期方法后，行 EGD 和 pH/阻抗探针检查以及 EGD 大体和显微镜下检查结果正常与 LTR 手术成功率增加独立相关。
4（回顾性队列研究）喉镜，131：E2356-E2362，2021。
