Schuering Juliëtta H C, van den Biesen Sophie L G, van Benthem Peter Paul G, Sjögren Elisabeth V, Langeveld Antonius P M
Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
Department of Otorhinolaryngology and Head & Neck Surgery, Leiden University Medical Center, Leiden, Zuid-Holland, The Netherlands.
J Voice. 2024 Dec 9. doi: 10.1016/j.jvoice.2024.11.036.
Serial intralesional steroid injections (SILSI) are increasingly used in the treatment of idiopathic subglottic stenosis (iSGS) and auto-immune related subglottic stenosis (SGS), which are both known for their high rate of recurrences. SILSI could potentially prolong the time to re-intervention. We evaluated the effects of adjuvant SILSI in iSGS and auto-immune related SGS-patients on time to reintervention and spirometry results.
A total of 16 consecutive subjects undergoing SILSI from 07/2018 were included in this consecutive case-series. All patients were treated with surgical endoscopic dilatation (ED) followed by SILSI (ED + SILSI). A subgroup of patients (no. 7/16) were previously also treated with solely ED. In this subgroup, outcome measures could be compared before and after adding SILSI within the same patient. Outcome measures included time to reintervention, side effects, and spirometry results expressed in Δarea under the curve/forced vital capicity (AUC).
Of all patients, 8/16 (50%) underwent at least one reintervention post ED + SILSI after a mean time of 14 months. In the subgroup, the median of the mean time to reintervention improved from 12 (interquartile range = 6) months post ED to 18 months (IQR = 8) post ED + SILSI. The median difference in AUC was 1.27 (P = 0.022; 95% CI: 0.51-3.05). No patients developed serious side effects during SILSI.
Adjuvant SILSI after ED potentially prolongs time to reintervention in iSGS and auto-immune SGS patients. It is, however, still unclear which patients benefit most. The decision to incorporate this adjuvant treatment should be made in shared decision making between surgeon and patient.
连续病灶内注射类固醇（SILSI）越来越多地用于治疗特发性声门下狭窄（iSGS）和自身免疫相关的声门下狭窄（SGS），这两种疾病均以高复发率而闻名。SILSI可能会延长再次干预的时间。我们评估了辅助SILSI对iSGS和自身免疫相关SGS患者再次干预时间和肺量计结果的影响。
本连续病例系列纳入了自2018年7月起连续接受SILSI治疗的16名受试者。所有患者均接受手术内镜扩张（ED），随后进行SILSI（ED + SILSI）。一部分患者（7/16）之前仅接受过ED治疗。在该亚组中，可以比较同一患者在添加SILSI之前和之后的结果指标。结果指标包括再次干预的时间、副作用以及以曲线下面积/用力肺活量（AUC）的变化表示的肺量计结果。
在所有患者中，8/16（50%）在ED + SILSI后平均14个月至少接受了一次再次干预。在亚组中，再次干预的平均时间中位数从ED后的12个月（四分位间距 = 6）提高到ED + SILSI后的18个月（IQR = 8）。AUC的中位数差异为1.27（P = 0.022；95% CI：0.51 - 3.05）。在SILSI期间没有患者出现严重副作用。
ED后辅助SILSI可能会延长iSGS和自身免疫性SGS患者再次干预的时间。然而，仍不清楚哪些患者获益最大。是否采用这种辅助治疗应在外科医生和患者共同决策后做出。
