Department of Otorhinolaryngology, Head and Neck Surgery, Lausanne University Hospital (CHUV), Lausanne, Switzerland.
Eur Arch Otorhinolaryngol. 2024 May;281(5):2531-2538. doi: 10.1007/s00405-024-08533-z. Epub 2024 Feb 26.
This study reports our experience with open reconstructive surgery in patients with laryngotracheal stenosis (LTS) following prolonged intubation and/or tracheostomy in the context of COVID-19.
All patients underwent a preoperative endoscopic airway assessment. Posterior glottic lesions were graded according to the Bogdasarian classification, subglottic-tracheal lesions according to the Cotton-Myers classification and postoperative complications reported by the Clavien-Dindo classification. We report postoperative outcomes and functional results in this patient subset.
We include 14 patients diagnosed to have post COVID LTS, one female and 13 males. This group was compared with a control group, diagnosed with LTS following prolonged intubation. In the COVID group, mean age of patients at the time of the airway surgery was 52.1 ± 16.8 years (range: 13.7-76.3). More than half the patients were multi-morbid with hypertension and obesity being the most common conditions. Eleven patients had multi-site stenoses. Open surgical interventions performed were tracheal resection and anastomosis, laryngotracheal reconstruction and extended cricotracheal resection, and postoperative complications were seen in 12 (85.6%) patients. 70% patients with pre-existing tracheostomy were decannulated. Oral swallowing was not tolerated in one-fifth of the patients and a significant number of them have poor voice quality.
Post-COVID pandemic, airway surgeons are seeing an increased number of patients with complex LTS, and we report significant postoperative complications in this patient subset. Decannulation rates, voice and swallowing results are poor in patients with glottic involvement as compared to isolated tracheal stenosis.
本研究报告了我们在 COVID-19 背景下，对因长时间插管和/或气管切开而导致喉气管狭窄（LTS）的患者进行开放式重建手术的经验。
所有患者均接受术前内镜气道评估。后声门病变根据 Bogdasarian 分类进行分级，声门下-气管病变根据 Cotton-Myers 分类进行分级，术后并发症根据 Clavien-Dindo 分类进行报告。我们在此患者亚组中报告术后结果和功能结果。
我们纳入了 14 例诊断为 COVID 后 LTS 的患者，其中 1 例为女性，13 例为男性。将该组与因长时间插管而诊断为 LTS 的对照组进行比较。在 COVID 组中，气道手术时患者的平均年龄为 52.1±16.8 岁（范围：13.7-76.3）。超过一半的患者患有多种疾病，高血压和肥胖症是最常见的疾病。11 例患者有多处狭窄。进行的开放式手术干预包括气管切除术和吻合术、喉气管重建和扩展环状软骨切除术，12 例（85.6%）患者出现术后并发症。70%有预先存在的气管造口术的患者可以拔管。五分之一的患者无法耐受口腔吞咽，相当数量的患者声音质量较差。
在 COVID-19 大流行之后，气道外科医生看到了越来越多的复杂 LTS 患者，我们在此患者亚组中报告了显著的术后并发症。与单纯气管狭窄相比，声门受累的患者拔管率、嗓音和吞咽效果较差。
