Pediatric Surgery Division & Pediatric Airway Unit, Hospital Universitario 12 de Octubre, Universidad Complutense de Madrid, Madrid, Spain.
Division of Pediatrics, Pulmonary Unit, Hospital Universitario 12 de Octubre, Madrid, Spain.
Pediatr Pulmonol. 2024 Oct;59(10):2517-2522. doi: 10.1002/ppul.27056. Epub 2024 May 9.
The aims of this study were to update our experience with biodegradable polydioxanone (PDO) airway stents in children, focusing on effectiveness and safety, and to analyze the factors involved in the different outcomes observed.
Retrospective study of patients managed with PDO stents from 2012 to 2023. Variables collected: demographics, comorbidities, indication, clinical baseline, stent size, location, complications, clinical outcome, and time of follow-up. Statistical analyses were performed to detect the eventual contribution of variables in the different outcomes observed.
Fifty-four PDO stents were placed in 26 patients (median age, 4 months). All showed severe symptoms of central airway obstruction due to tracheomalacia in nine patients, bronchomalacia five, tracheobronchomalacia 10, and tracheal stenosis two. Stent placement was uneventful in every case: 29 stents in the trachea and 25 in the main bronchi. 53.8% of patients needed successive stenting, and all exhibited comorbidities. Complete clinical resolution was observed in eight cases (30.7%), partial improvement in 13 (50%), unchanged in 4 (15.3%), and worsened in one. Age had a significant positive impact on outcome (6 vs. 3 months; p = 0.024). Additionally, smaller stents were associated with a better outcome (20 vs. 26 mm; p = 0.044). Granulation tissue was the most frequent complication (34.6%). Five patients (19.2%) died due to severe comorbidities, follow-up was complete in survivors (median, 58 months).
PDO stents are safe and effective when dealing with severe tracheobronchial obstruction. Stent-related granulation tissue continues to be a relevant matter of concern. This issue, together with increased degradation times, deserves further research.
本研究旨在更新我们在儿童中使用可生物降解的聚二氧杂环已酮（PDO）气道支架的经验，重点关注其有效性和安全性，并分析观察到不同结果涉及的因素。
回顾性研究 2012 年至 2023 年期间接受 PDO 支架治疗的患者。收集的变量：人口统计学、合并症、适应证、临床基线、支架大小、位置、并发症、临床结果和随访时间。进行统计分析以检测不同观察结果中变量的潜在贡献。
26 例患者共放置 54 个 PDO 支架（中位年龄 4 个月）。所有患者均因气管软化症导致中央气道阻塞而出现严重症状，其中 9 例为气管软化症，5 例为支气管软化症，10 例为气管支气管软化症，2 例为气管狭窄。支架置入在所有病例中均顺利进行：29 个支架位于气管，25 个位于主支气管。53.8%的患者需要连续支架置入，所有患者均存在合并症。8 例（30.7%）患者完全临床缓解，13 例（50%）部分改善，4 例（15.3%）无变化，1 例恶化。年龄对结果有显著的积极影响（6 个月 vs. 3 个月；p=0.024）。此外，较小的支架与更好的结果相关（20 毫米 vs. 26 毫米；p=0.044）。肉芽组织是最常见的并发症（34.6%）。5 例（19.2%）患者因严重合并症死亡，幸存者的随访完整（中位数 58 个月）。
PDO 支架在处理严重气管支气管阻塞时安全有效。支架相关的肉芽组织仍然是一个值得关注的重要问题。这个问题，以及降解时间的增加，值得进一步研究。
