Department of Otolaryngology - Head & Neck Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA.
Department of Pediatric Otolaryngology, Children's Medical Center Dallas, Dallas, TX, USA.
Ann Otol Rhinol Laryngol. 2021 Aug;130(8):948-953. doi: 10.1177/0003489420987426. Epub 2021 Jan 8.
Tracheocutaneous fistula (TCF) is a common occurrence after pediatric tracheostomy decannulation. However, the persistence of TCF after staged reconstruction of the pediatric airway is not well-described. The primary objective was to determine the rate of persistent TCF after successful decannulation in children with staged open airway reconstruction.
A case series with chart review of children who underwent decannulation after double-stage laryngotracheal reconstruction between 2017 and 2019.
A total of 26 children were included. The most common open airway procedure was anterior and posterior costal cartilage grafting (84.6%, 22/26). Median age at decannulation was 3.4 years (IQR: 2.8-4.3) and occurred 7.0 months (IQR: 4.3-10.4) after airway reconstruction. TCF persisted in 84.6% (22/26) of children while 15.4% (4/26) of stomas closed spontaneously. All closures were identified by the one-month follow-up visit. There was no difference in age at tracheostomy ( = .86), age at decannulation ( = .97), duration of tracheostomy ( = .43), or gestational age ( = .23) between stomas that persisted or closed. Median diameter of stent used at reconstruction was larger in TCFs that persisted (7.0 mm vs 6.5 mm, = .03). Tracheostomy tube diameter ( = .02) and stent size ( < .01) correlated with persistence of TCF on multivariable logistic regression analysis. There were 16 surgical closure procedures, which occurred at a median of 14.4 months (IQR: 11.4-15.4) after decannulation. Techniques included 56.3% (9/16) by primary closure, 18.8% (3/16) by secondary intention and 25% (4/16) by cartilage tracheoplasty. The overall success of closure was 93.8% (15/16) at latest follow-up.
Persistent TCF occurs in 85% of children who are successfully decannulated after staged open airway reconstruction. Spontaneous closure could be identified by 1 month after decannulation and was more likely when smaller stents and tracheostomy tubes were utilized. Surgeons should counsel families on the frequency of TCF and the potential for additional procedures needed for closure.
气管切开造口拔管后，气管皮瘘（TCF）是一种常见的并发症。然而，小儿气道分期重建后 TCF 的持续存在情况尚未得到很好的描述。本研究的主要目的是确定分期开放式气道重建后小儿拔管成功后 TCF 的持续率。
这是一项病例系列研究，对 2017 年至 2019 年间接受双阶段喉气管重建后拔管的患儿进行了图表回顾。
共纳入 26 例患儿。最常见的开放式气道手术是前路和后路肋软骨移植（84.6%，22/26）。拔管的中位年龄为 3.4 岁（IQR：2.8-4.3），拔管时间为气道重建后 7.0 个月（IQR：4.3-10.4）。26 例患儿中有 84.6%（22/26）的患儿存在 TCF，15.4%（4/26）的患儿的气管造口自行关闭。所有的关闭都在一个月的随访中发现。气管造口术时的年龄（ = .86）、拔管时的年龄（ = .97）、气管造口术的持续时间（ = .43）和胎龄（ = .23）在持续存在和关闭的造口之间无差异。重建时使用的支架中位直径在持续存在 TCF 的患儿中更大（7.0mm 比 6.5mm， = .03）。气管造口管直径（ = .02）和支架大小（ < .01）与 TCF 的持续存在相关，这在多变量逻辑回归分析中得到了验证。有 16 例患儿进行了手术闭合，中位时间为拔管后 14.4 个月（IQR：11.4-15.4）。手术方法包括 56.3%（9/16）一期缝合、18.8%（3/16）二期缝合和 25%（4/16）软骨气管成形术。在最新的随访中，15 例（93.8%）患儿的闭合完全成功。
分期开放式气道重建后成功拔管的患儿中，85%存在持续 TCF。拔管后 1 个月即可通过观察来确定 TCF 是否自行关闭，使用较小的支架和气管造口管更有可能自行关闭。外科医生应告知患儿家属 TCF 的发生频率以及可能需要进行额外的闭合手术。
