Department of Otolaryngology and Oral and Maxillofacial Surgery, Shanghai Children's Medical Center, School of Medicine, Shanghai Jiao Tong University, Shanghai, China.
Department of Otolaryngology Head and Neck Surgery, Maternal and Child Health Hospital of Guangxi Zhuang Autonomous Region, Nanning, China.
Auris Nasus Larynx. 2024 Feb;51(1):161-166. doi: 10.1016/j.anl.2023.07.004. Epub 2023 Aug 4.
To summarise our experience and the outcomes of endoscopic balloon dilatation (EBD) in the management of paediatric-acquired subglottic stenosis (SGS), and to further explore the influencing factors of successful EBD.
A retrospective case series study was conducted involving 33 paediatric patients diagnosed with acquired SGS who underwent EBD as the primary treatment from January 2012 to December 2021. The collected information included patient demographics, aetiology, time from extubation to operation, initial grade of SGS, descriptions of stenosis tissues, presence of tracheotomy, number of dilatation procedures and co-morbidity. The follow-up results were collected and analysed.
Thirty-three paediatric patients with an average age of 31.0 months who underwent EBD were included in the study. According to the Myers-Cotton classification, four (12.1%) patients had Grade I stenosis, nine (27.3%) had Grade II, 20 (60.6%) had Grade III and none had Grade IV. Of these, 15 (45.5%) exhibited acute lesions and 18 (54.5%) exhibited chronic lesions. The mean number of dilatation procedures per patient was 1.88 ± 1.05, and 19 (57.6%) patients received dilatations more than once. The overall success rate was 72.7%, with 100% for Grade I, 88.9% for Grade II and 60.0% for Grade III. There was a significant difference between the distribution of the stenosis grades in the successful and failed cases (p < 0.05). The mean number of dilatation procedures was 1.47 ± 0.64 and 2.22 ± 1.22 per patient in those with acute lesions and chronic lesions, respectively. The patients with chronic lesions had a significantly higher number of dilatations than those with acute lesions (p < 0.05). The success rate was 86.7% for acute lesions and 61.1% for chronic lesions. The correlation between the type of subglottic lesions and procedural success was not statistically significant (p > 0.05).
Acquired SGS in paediatric patients can be successfully managed using EBD. The dilatation procedures should be performed in a timely manner, early treatment could prevent the need for multiple procedures and smaller stenosis grades could improve the success rate of the surgery.
总结我们在儿童获得性声门下狭窄（SGS）的内镜球囊扩张（EBD）管理方面的经验和结果，并进一步探讨 EBD 成功的影响因素。
回顾性病例系列研究纳入了 2012 年 1 月至 2021 年 12 月期间因获得性 SGS 接受 EBD 作为主要治疗的 33 例儿科患者。收集的信息包括患者人口统计学、病因、拔管至手术的时间、SGS 的初始分级、狭窄组织描述、是否存在气管切开术、扩张程序数量和合并症。收集并分析随访结果。
本研究纳入了 33 例平均年龄为 31.0 个月的接受 EBD 的儿科患者。根据 Myers-Cotton 分级，4 例（12.1%）患者为 I 级狭窄，9 例（27.3%）为 II 级，20 例（60.6%）为 III 级，无 IV 级。其中 15 例（45.5%）为急性病变，18 例（54.5%）为慢性病变。每位患者的平均扩张次数为 1.88 ± 1.05，19 例（57.6%）患者接受了不止一次扩张。总体成功率为 72.7%，I 级为 100%，II 级为 88.9%，III 级为 60.0%。成功组和失败组的狭窄分级分布差异有统计学意义（p < 0.05）。急性病变和慢性病变患者的平均扩张次数分别为 1.47 ± 0.64 和 2.22 ± 1.22 次。慢性病变患者的扩张次数明显多于急性病变患者（p < 0.05）。急性病变的成功率为 86.7%，慢性病变的成功率为 61.1%。声门下病变类型与手术成功率之间无统计学相关性（p > 0.05）。
儿童获得性 SGS 可通过 EBD 成功治疗。扩张程序应及时进行，早期治疗可避免多次手术，较小的狭窄分级可提高手术成功率。
