Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, U.S.A.
Division of Pediatric Otolaryngology-Head and Neck Surgery, Children's Minnesota, Minneapolis, Minnesota, U.S.A.
Laryngoscope. 2021 Dec;131(12):2798-2804. doi: 10.1002/lary.29608. Epub 2021 May 25.
OBJECTIVES/HYPOTHESIS: Evaluate swallowing and airway outcomes following laryngotracheoplasty with posterior grafting (LTP PCCG).
Retrospective review of pediatric patients undergoing LTP PCCG from 2016 to 2019 at a tertiary care pediatric hospital. We included demographics, indications, approach, and revision status. We evaluated preoperative and postoperative instrumental and functional swallow evaluations, and we also gathered information on airway outcomes.
Thirty-one patients were included in the study. Median (interquartile range [IQR]) age was 4.0 (2.0, 7.0) years old. Primary indication for surgery was bilateral vocal cord immobility (BVCI) in 11 (35.5%) and posterior glottic stenosis (PGS) in 20 (64.5%). Mean (standard deviation) length of follow-up was 11.0 (8.3) months. Twelve patients had gastrostomy tubes (GT) before surgery, and no patients required placement of GT after surgery. Of the remaining 19 patients, 6 required nasogastric feeding for >4 weeks (average length 1.8 months, longest 3.5 months). At last follow-up, 25 (80.6%) patients were primarily orally fed. Eighteen patients had tracheotomies prior to surgery. No patients without a tracheostomy required placement of tracheostomy before or after surgery and only 1 patient had a tracheostomy at last follow-up. Average time to decannulation was 3.7 months, with surgery-specific success of 87.1% and overall success of 96.8%. Four (12.9%) patients required a major intervention to achieve decannulation.
LTP PCCG is an effective surgical technique to address PGS and BVCI with high decannulation rates. It may cause temporary swallowing dysfunction, but in this series a majority of children were orally fed at last follow-up.
4 Laryngoscope, 131:2798-2804, 2021.
目的/假设：评估喉气管成形术加后外侧移植物（LTP PCCG）后的吞咽和气道结果。
对 2016 年至 2019 年在一家三级儿童保健医院接受 LTP PCCG 的儿科患者进行回顾性研究。我们纳入了人口统计学、适应证、方法和修订状态。我们评估了术前和术后仪器和功能吞咽评估，还收集了气道结果的信息。
研究纳入 31 例患者。中位（四分位距 [IQR]）年龄为 4.0（2.0，7.0）岁。手术的主要适应证为双侧声带运动障碍（BVCI）11 例（35.5%）和后声门狭窄（PGS）20 例（64.5%）。平均（标准差）随访时间为 11.0（8.3）个月。术前有 12 例患者有胃造口管（GT），术后无患者需要放置 GT。其余 19 例患者中，6 例需要鼻饲 >4 周（平均 1.8 个月，最长 3.5 个月）。最后随访时，25 例（80.6%）患者主要经口喂养。术前 18 例患者有气管切开术。无无气管切开术的患者术前或术后需要放置气管切开术，仅 1 例患者最后随访时仍有气管切开术。拔管平均时间为 3.7 个月，手术特异性成功率为 87.1%，总体成功率为 96.8%。4 例（12.9%）患者需要主要干预才能实现拔管。
LTP PCCG 是一种有效的手术技术，可治疗 PGS 和 BVCI，且拔管率较高。它可能导致暂时性吞咽功能障碍，但在本系列中，大多数儿童在最后随访时经口进食。
4 级喉镜，131：2798-2804，2021。
