声门型与多水平气道狭窄的干预措施和结果：一项多机构回顾。
Interventions and Outcomes in Glottic Versus Multi-level Airway Stenosis: A Multi-institutional Review.
机构信息
Wake Forest School of Medicine, Winston-Salem, North Carolina, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, University of California-San Francisco Voice and Swallowing Center, San Francisco, California, U.S.A.
出版信息
Laryngoscope. 2023 Mar;133(3):528-534. doi: 10.1002/lary.30269. Epub 2022 Jul 9.
OBJECTIVE
Airway stenosis-particularly multi-level-presents complex management challenges. This study assessed rates of tracheostomy, decannulation, and the number of surgeries required in patients with posterior glottic stenosis (PGS), multi-level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP).
METHODS
Airway stenosis patients treated between 2016 and 2021 at three tertiary medical centers were identified. Demographics, etiology of stenosis, medical comorbidities, and patient-reported outcome measures (PROMs) were collected.
RESULTS
158 patients (84 women, mean age 56.98 ± 15.5 years) were identified (54 PGS, 38 MLAS, and 66 BVFP). 72.3% required tracheostomy, including 72.2%, 86.8%, and 63.6% in these groups, respectively. Decannulation rates were 43.6%, 21.2%, and 32.5% in these groups, respectively. Patients with MLAS had higher rates of tracheostomy than BVFP (p < 0.05). However, decannulation rates were not different between groups (p > 0.05). MLAS required more surgeries (mean 4.0 ± 3.9) than PGS (2.4 ± 2.2, p = 0.02) or BVFP (1.0 ± 1.8, p < 0.0001). Mean PROMs scores at the latest follow-up were abnormal: 15.4 ± 12.2 (Dyspnea Index), 19.9 ± 12.2 (Voice Handicap Index-10), and 9.67 ± 11.1 (Eating Assessment Tool-10). Co-morbidities present included body mass index >30 (41.4%), diabetes (31.8%), pulmonary disease (50.7%), gastroesophageal reflux disease (39.4%), autoimmune disease (22.9%), and tobacco use history (55.2%).
CONCLUSIONS
Airway stenosis is a challenging clinical problem that negatively impacts patients' quality of life and often requires numerous surgeries. PGS more frequently requires tracheostomy compared to BVFP, but patients can often decannulate successfully. Patients with multi-level stenosis have lower decannulation rates and require more surgeries than glottic stenosis alone; these patients may benefit from earlier and/or more aggressive intervention.
LEVEL OF EVIDENCE
4 Laryngoscope, 133:528-534, 2023.
目的
气道狭窄-特别是多水平气道狭窄-带来了复杂的管理挑战。本研究评估了后声门狭窄（PGS）、多水平气道狭窄（MLAS）和双侧声带麻痹（BVFP）患者行气管切开术、拔管和所需手术次数的比例。
方法
在三个三级医疗中心确定了 2016 年至 2021 年间治疗的气道狭窄患者。收集了患者的人口统计学、狭窄病因、合并症和患者报告的结果测量（PROMs）。
结果
共确定了 158 名患者（84 名女性，平均年龄 56.98±15.5 岁）（54 名 PGS、38 名 MLAS 和 66 名 BVFP）。72.3%的患者需要行气管切开术，其中这三组患者分别为 72.2%、86.8%和 63.6%。拔管率分别为 43.6%、21.2%和 32.5%。MLAS 患者的气管切开术比例高于 BVFP（p<0.05）。然而，两组间的拔管率无差异（p>0.05）。MLAS 比 PGS（2.4±2.2，p=0.02）或 BVFP（1.0±1.8，p<0.0001）需要更多的手术。最近一次随访时，平均 PROMs 评分异常：呼吸困难指数 15.4±12.2，嗓音障碍指数-10 评分 19.9±12.2，饮食评估工具-10 评分 9.67±11.1。存在的合并症包括体重指数>30（41.4%）、糖尿病（31.8%）、肺部疾病（50.7%）、胃食管反流病（39.4%）、自身免疫性疾病（22.9%）和吸烟史（55.2%）。
结论
气道狭窄是一个具有挑战性的临床问题，会对患者的生活质量产生负面影响，并且经常需要多次手术。PGS 比 BVFP 更常需要行气管切开术，但患者通常可以成功拔管。多水平狭窄患者的拔管率较低，手术次数多于单纯声门狭窄患者；这些患者可能受益于更早和/或更积极的干预。
证据水平
4 级喉镜，133：528-534，2023 年。
Zotero 插件