Division of Pediatric Surgery, St. Marianna University School of Medicine, 2-16-1 Sugao, Miyamae-ku, Kawasaki, 241-8511, Japan.
Pediatr Surg Int. 2021 May;37(5):555-559. doi: 10.1007/s00383-020-04812-y. Epub 2021 Jan 24.
We have reviewed the surgical procedures performed and outcomes for low-birth-weight infants with acquired subglottic stenosis.
The gestational age at birth, birth weight, age at Laryngotracheal reconstruction, and therapeutic outcome over the past 26 years were reviewed. Laryngotracheal reconstruction was initially performed by costochondral grafting involving only the anterior wall for the first operation, but since 2010 a costal cartilage was also inserted into the posterior wall of the cricoid cartilage using the BENSON pylorus spreader to split the cartilage.
There were 21 patients. The mean gestational age was 29.6 weeks, the mean birth weight was 1127 g, and the first surgery was performed at a mean age of 37.0 ± 21.8 months. Extubation was possible in 11 of 21 patients (52.3%) after the first surgery and in 7 of 7 patients after re-operation. The total extubation rate reached 100% (18/18) excluding three patients (one who suffered sudden death, and two who were lost to follow-up).
Sufficient dilatation of the subglottic space could not be achieved by costochondral grafting involving the anterior wall alone. The extubation rate was improved by dilatation of the posterior wall and the insertion of costal cartilage into both the anterior and posterior walls.
我们回顾了患有获得性声门下狭窄的低体重儿所施行的手术程序和结果。
回顾了过去 26 年来的出生胎龄、出生体重、行喉气管重建术的年龄以及治疗结果。喉气管重建术最初仅在前壁行肋软骨移植，但自 2010 年以来，使用 BENSON 幽门扩张器将肋软骨插入环状软骨的后壁，以分割软骨，从而在后壁也插入了肋软骨。
共有 21 例患者。平均胎龄为 29.6 周，平均出生体重为 1127g，第一次手术的平均年龄为 37.0±21.8 个月。21 例患者中有 11 例（52.3%）在第一次手术后可以拔管，7 例患者在再次手术后可以拔管。排除 3 例患者（1 例猝死，2 例失访）后，总拔管率达到 100%（18/18）。
仅在前壁行肋软骨移植无法充分扩张声门下间隙。通过扩张后壁并将肋软骨插入前壁和后壁，可以提高拔管率。
