Xie Katherine Z, Bowen Andrew Jay, Richards Bradley A, Aden Aisha, Wiedermann Joshua, Rutt Amy L, Vassallo Robert, Edell Eric S, Bayan Semirra L, Kasperbauer Jan L, Ekbom Dale C
Alix School of Medicine, Mayo Clinic, Rochester, Minnesota, U.S.A.
Department of Otolaryngology-Head and Neck Surgery, Mayo Clinic, Rochester, Minnesota, U.S.A.
Laryngoscope. 2023 Apr;133(4):875-882. doi: 10.1002/lary.30292. Epub 2022 Jul 18.
To compare the incidence of glottic stenosis in idiopathic subglottic stenosis (iSGS) patients with no prior surgical intervention to those with a history of endoscopic dilation and characterize the incidence of glottic involvement, changes in scar length, and progression of scar toward glottis following laser wedge excision (LWE).
A retrospective review of iSGS patients who underwent LWE between 2002 and 2021 was performed. Patients without prior airway surgery were labeled LWE primary (LWEP) and operative findings for LWEP patients were reviewed for glottic involvement, scar length (D ), and distance from the glottis to superior-most aspect of scar (D ). Rates (in mm/procedure) of D , reflecting an increase in length, and D , reflecting proximal migration, were calculated by dividing D and D by the number of LWE procedures.
213 iSGS patients underwent LWE, with 132 being LWEP patients. LWEP had a lower incidence of baseline glottic involvement (n = 6, 4.5%) than LWE secondary (LWES; n = 6, 7.5%). Four new cases of glottic involvement were noted in LWEP patients following LWE, with only one being clinically significant resulting in permanently decreased vocal fold mobility. With each procedure, scar length increased by 1.0 mm and D decreased by 0.7 mm, reflecting a migration or decrease in D of 9.5% with each procedure with respect to initial D . Overall rates of glottic stenosis following operations were similar between LWEP and LWES cohorts, 7.6% and 7.5% respectively.
There appears to be a low risk of glottic involvement resulting from the LWE procedure in iSGS patients.
4 Laryngoscope, 133:875-882, 2023.
比较未经手术干预的特发性声门下狭窄（iSGS）患者与有内镜扩张病史的患者声门狭窄的发生率，并描述声门受累的发生率、瘢痕长度变化以及激光楔形切除术（LWE）后瘢痕向声门进展的情况。
对2002年至2021年间接受LWE的iSGS患者进行回顾性研究。无既往气道手术史的患者标记为LWE初治组（LWEP），对LWEP患者的手术结果进行评估，以确定声门受累情况、瘢痕长度（D）以及从声门到瘢痕最上端的距离（D）。通过将D和D除以LWE手术次数来计算反映长度增加的D和反映近端迁移的D的发生率（单位为mm/次手术）。
213例iSGS患者接受了LWE，其中132例为LWEP患者。LWEP患者基线声门受累的发生率（n = 6，4.5%）低于LWE复治组（LWES；n = 6，7.5%）。LWEP患者在LWE后有4例新的声门受累病例，其中只有1例具有临床意义，导致声带活动度永久性下降。每次手术，瘢痕长度增加1.0mm，D减少0.7mm，这反映出每次手术相对于初始D，D的迁移或减少为9.5%。LWEP组和LWES组术后声门狭窄的总体发生率相似，分别为7.6%和7.5%。
iSGS患者接受LWE手术导致声门受累的风险似乎较低。
4 《喉镜》，133:875 - 882，2023年。
