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[严重小儿声门下狭窄或喉蹼行前后肋软骨移植喉气管重建的结果]

[Outcomes of laryngotracheal reconstruction with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis or laryngeal web].

作者信息

Tan L T, Xie Y, Li Q, Chen C

机构信息

Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai 201100, China.

Department of General Surgery, PLA Naval medical center, Shanghai 200052, China.

出版信息

Zhonghua Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2023 Jul 7;58(7):699-704. doi: 10.3760/cma.j.cn115330-20221124-00708.

Abstract

To investigate outcomes of laryngotracheal reconstruction (LTR)with anterior and posterior costal cartilage grafts in severe pediatric subglottic stenosis (SGS) or laryngeal web (LW). A review of patients with severe subglottic stenosis or laryngeal web between January 2020 and January 2022 was performed. Demographic features including gender, age at diagnosis, age at surgery, etiology, airway support, and other comorbidities were collected preoperatively. Patients were evaluated in surgical site, breathing, swallowing, phonation and complications postoperatively.Descriptive analysis was used in this research. Eight patients were included: six with grade Ⅲ SGS following Cotton-Myer grading scale, and two with type Ⅲ LW following Cohen's classification. All patients underwent LTR with anterior and posterior costal cartilage grafts. Five patients underwent single-stage LTR (ssLTR), and three patients underwent double-stage LTR (dsLTR). Seven out of eight patients were able to successfully extubate or decannulate with normal swallowing function; four patients had mild hoarseness, and three had moderate hoarseness. One patient failed in extubation, and underwent tracheotomy. LTR with anterior and posterior costal cartilage grafts is an effective and safe treatment for severe SGS or LW. Careful preoperative assessment of disease severity and overall medical status will help selection between ssLTR and dsLTR, thereby maximizing patient outcomes for both modalities.

摘要

探讨采用前后肋软骨移植进行喉气管重建(LTR)治疗小儿重度声门下狭窄(SGS)或喉蹼(LW)的疗效。对2020年1月至2022年1月期间患有重度声门下狭窄或喉蹼的患者进行了回顾性研究。术前收集患者的人口统计学特征,包括性别、诊断年龄、手术年龄、病因、气道支持情况及其他合并症。术后对患者的手术部位、呼吸、吞咽、发声及并发症情况进行评估。本研究采用描述性分析。共纳入8例患者:按照Cotton-Myer分级标准,6例为Ⅲ级SGS;按照Cohen分类,2例为Ⅲ型LW。所有患者均接受了前后肋软骨移植的LTR手术。5例患者接受了单阶段LTR(ssLTR),3例患者接受了双阶段LTR(dsLTR)。8例患者中有7例能够成功拔管或脱管,吞咽功能正常;4例患者有轻度声音嘶哑,3例有中度声音嘶哑。1例患者拔管失败,接受了气管切开术。采用前后肋软骨移植的LTR是治疗重度SGS或LW的一种有效且安全的方法。术前仔细评估疾病严重程度和整体健康状况有助于在ssLTR和dsLTR之间做出选择,从而使两种手术方式的患者预后最大化。

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