Department of Otolaryngology-Head and Neck Surgery, School of Medicine, Shanghai Children's Hospital, Shanghai Jiao Tong University, No. 24, Lane 1400, West Beijing Road, Shanghai, 200040, People's Republic of China.
Eur Arch Otorhinolaryngol. 2023 Jun;280(6):2859-2864. doi: 10.1007/s00405-023-07826-z. Epub 2023 Jan 6.
To assess efficacy and prognostic factors of endoscopic balloon dilatation for the treatment of subglottic stenosis in children.
A retrospective review was performed on 49 pediatric patients with subglottic stenosis treated at the Shanghai Children's Hospital between December 2017 and December 2021. Specific demographic data, type and severity of the stenosis, number of balloon dilatations and outcomes were recorded and analyzed.
Forty-nine children (30 male, 19 female) were included in the study with a median age at diagnosis of 24 (13-36.5) months, of which 7 (14.3%) had received open laryngotracheal reconstruction previously. The degree of subglottic stenosis was grade I in six patients, grade II in 16 patients, grade III in 20 patients and grade IV in seven patients. After various numbers of balloon dilatations (1-7 times), 29 patients showed a good outcome (decannulation or prevention of tracheostomy) and the success rate in that series was 59.2%. Overall, prognosis of balloon dilatation was not dependent on pathogeny (congenital or acquired) or open surgical history(P > 0.05), but rather on the severity grade of stenosis and the number of dilatations (P < 0.05).
Endoscopic balloon dilatation can be safe and effective in the treatment of subglottic stenosis in children, except for more serious cases (grade IV). Open surgery should be considered if no significant improvement is observed after dilatation, especially after three or more dilatations.
评估内镜球囊扩张治疗儿童声门下狭窄的疗效和预后因素。
对 2017 年 12 月至 2021 年 12 月在上海儿童医学中心接受治疗的 49 例儿童声门下狭窄患者进行回顾性分析。记录并分析患者的具体人口统计学数据、狭窄的类型和严重程度、球囊扩张次数和结果。
本研究共纳入 49 例患儿（男 30 例，女 19 例），中位诊断年龄为 24（13-36.5）个月，其中 7 例（14.3%）曾行开放性喉气管重建术。声门下狭窄程度为Ⅰ度 6 例，Ⅱ度 16 例，Ⅲ度 20 例，Ⅳ度 7 例。经过不同次数的球囊扩张（1-7 次），29 例患儿取得良好的结局（拔管或避免气管切开），该组的成功率为 59.2%。总体而言，球囊扩张的预后与病因（先天性或获得性）或开放手术史无关（P＞0.05），但与狭窄严重程度分级和扩张次数有关（P＜0.05）。
除了更严重的病例（Ⅳ度）外，内镜球囊扩张治疗儿童声门下狭窄是安全有效的。如果扩张后无明显改善，特别是扩张 3 次或以上后，应考虑行开放手术。
