Pasick Luke J, Anis Mursalin M, Rosow David E
Department of Otolaryngology-Head & Neck Surgery, University of Miami Miller School of Medicine, 1120 NW 14th St, 5th Floor, Miami, FL 33136 USA.
Curr Pulmonol Rep. 2022;11(2):29-38. doi: 10.1007/s13665-022-00286-6. Epub 2022 Mar 3.
To assimilate the newly published literature regarding subglottic stenosis (SGS), including basic science and translational research on mechanisms of etiology, clinical diagnostics, and therapeutic treatments.
The role of inflammation in development of iatrogenic and idiopathic SGS (iSGS) is continuing to be studied. The IL-23/IL-17A inflammatory axis appears to be a potential mechanism for development of iSGS. Additionally, as anticipated in an inflammatory milieu, PD-1/PD-L1 expression is upregulated. If the PD-1/PD-L1 axis is important in SGS pathogenesis, then it may represent a potential target for immunotherapeutic inhibition, given its success in cancer treatment. In terms of surgical management, prospective studies show that endoscopic approaches have more frequent recurrence compared to open techniques.
SGS arises from various etiologies, and further understanding of its pathogenesis can aid in the development of novel therapies. It is imperative to obtain a thorough history for each patient presenting with respiratory complaints, as misdiagnosis can delay proper treatment. Endoscopic and open surgical techniques continue to be investigated in a growing number of prospective clinical trials to determine optimal treatment protocols. In-office injections are gaining popularity and show promise in the treatment of SGS.
总结近期发表的关于声门下狭窄（SGS）的文献，包括病因机制的基础科学和转化研究、临床诊断及治疗方法。
炎症在医源性和特发性声门下狭窄（iSGS）发展中的作用仍在研究中。白细胞介素-23/白细胞介素-17A炎症轴似乎是iSGS发展的潜在机制。此外，正如在炎症环境中所预期的，程序性死亡受体-1/程序性死亡配体-1（PD-1/PD-L1）表达上调。如果PD-1/PD-L1轴在SGS发病机制中起重要作用，鉴于其在癌症治疗中的成功，那么它可能代表免疫治疗抑制的潜在靶点。在手术治疗方面，前瞻性研究表明，与开放手术相比，内镜手术的复发率更高。
SGS由多种病因引起，进一步了解其发病机制有助于开发新的治疗方法。对于每一位有呼吸道症状的患者，全面了解病史至关重要，因为误诊会延误正确治疗。越来越多的前瞻性临床试验正在研究内镜和开放手术技术，以确定最佳治疗方案。门诊注射越来越受欢迎，在SGS治疗中显示出前景。
