Lambercy Karma, Pincet Laurence, Sandu Kishore
Head and Neck Surgery Department, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
Front Pediatr. 2021 Feb 10;9:594832. doi: 10.3389/fped.2021.594832. eCollection 2021.
Laryngeal intubation related lesions (LIRL) in pediatric patients cause extreme morbidity in both elective and emergency settings. It has a wide range of presentations from minor laryngeal edema to a life-threatening airway obstruction. We report here our units' experience with LIRL in neonates, infants, and small children. This is a retrospective monocentric cohort study between January 2013 and April 2019. Thirty-nine patients with intubation lesions were included in the study. We looked at the lesions type, characteristics, management, and outcome. Half the patients were premature and having comorbidities. Main LIRL were subglottic stenosis (31%), ulcers (26%), granulations (18%), retention cysts (18%), posterior glottic stenosis (13%), and vocal cords edema (5%). Unfavorable lesions causing airway stenosis were associated with an intubation duration of over 1 week and were an important factor in causing airway stenosis ( < 0.05). The endoscopic treatment performed for these lesions was lesion and anatomical site-specific. Tracheostomy was needed in five patients, and was avoided in another two. Seven patients (18%) received open surgery prior to their decannulation. LIRL management is challenging and stressful in the pediatric population and optimal treatment could avoid extreme morbidity in them. Intubation duration and associated comorbidities are important factors in deciding the severity of these lesions. Protocols to prevent the formation of these lesions are critical.
儿科患者的喉插管相关病变（LIRL）在择期和急诊情况下都会导致极高的发病率。其表现形式多样，从轻微的喉水肿到危及生命的气道梗阻。我们在此报告我们科室在新生儿、婴儿和幼儿中处理LIRL的经验。这是一项2013年1月至2019年4月间的回顾性单中心队列研究。39例有插管病变的患者被纳入研究。我们观察了病变类型、特征、处理方法及结果。半数患者为早产儿且伴有合并症。主要的LIRL包括声门下狭窄（31%）、溃疡（26%）、肉芽组织（18%）、潴留囊肿（18%）、后声门狭窄（13%）和声带水肿（5%）。导致气道狭窄的不良病变与插管时间超过1周相关，且是导致气道狭窄的重要因素（<0.05）。针对这些病变所进行的内镜治疗是根据病变及解剖部位而定的。5例患者需要行气管切开术，另外2例避免了气管切开术。7例患者（18%）在拔管前接受了开放手术。在儿科人群中，LIRL的处理具有挑战性且压力巨大，而最佳治疗可避免他们出现极高的发病率。插管时间及相关合并症是决定这些病变严重程度的重要因素。预防这些病变形成的方案至关重要。
