Department of Otolaryngology-Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai, 201102, China.
Eur Arch Otorhinolaryngol. 2024 Sep;281(9):4881-4887. doi: 10.1007/s00405-024-08701-1. Epub 2024 May 18.
To describe the clinical outcomes of patients who underwent surgical repair through an anterior approach that involved interposition a posterior cartilage for Type III or Type IV laryngotracheoesophageal cleft (LTEC).
A chart view was performed on patients with Type III or Type IV LTEC between May 2017 and May 2022. Demographic features and surgical outcomes were collected and analyzed.
Seven patients were finally included. Five patients were diagnosed with Type III LTEC and two patients were diagnosed with Type IV LTEC. All but one patients survived and thrived. Four patients were able to successfully extubate with acceptable voice, and two patients were tracheostomized. Five patients were deemed safe for all consistencies food and one was safe for thickened food. After a mean follow-up of 49 months (18-83 months), neither complications nor recurrences were observed.
An anterior laryngofissure approach to the cleft repair with a posterior cartilage grafting is an effective and safe treatment for Type III or IV LTEC, which enables closure of LTEC and reconstruction of cricoid plate in order to avoid tracheoesophageal fistula formation or subglottic stenosis postoperatively. Severe tracheomalacia and GERD are two main causes for surgical failure.
描述通过前路手术修复 III 型或 IV 型喉气管食管裂(LTEC)患者的临床结果,该手术涉及使用后软骨进行隔垫。
对 2017 年 5 月至 2022 年 5 月期间的 III 型或 IV 型 LTEC 患者进行图表回顾。收集并分析人口统计学特征和手术结果。
最终纳入 7 名患者。5 名患者诊断为 III 型 LTEC,2 名患者诊断为 IV 型 LTEC。除 1 名患者外,所有患者均存活并康复。4 名患者能够成功拔管,声音可接受,2 名患者行气管切开术。5 名患者可安全进食各种质地的食物,1 名患者可安全进食增稠食物。平均随访 49 个月(18-83 个月)后,未观察到并发症或复发。
对于 III 型或 IV 型 LTEC,采用前路喉裂开术联合后软骨移植是一种有效且安全的治疗方法,可实现 LTEC 的闭合和环状软骨板的重建,从而避免术后气管食管瘘或声门下狭窄的形成。严重的气管软化和 GERD 是手术失败的两个主要原因。