Li Qi, Wang Pengcheng, Ni Yihua, Tan Letian, Xu Zhengmin, Chen Chao
Department of Otorhinolaryngology Head and Neck Surgery，Children's Hospital of Fudan University，Shanghai，201102，China.
Lin Chuang Er Bi Yan Hou Tou Jing Wai Ke Za Zhi. 2025 Feb;39(2):124-127. doi: 10.13201/j.issn.2096-7993.2025.02.005.
To investigate the outcomes of endoscopic balloon dilation laryngoplasty （EBDL） in managing acquired subglottic stenosis in children. A retrospective analysis of clinical data from patients who underwent endoscopic balloon dilation for secondary subglottic stenosis between January 2017 and January 2024 at Department of Otorhinolaryngology Head and Neck Surgery, Children's Hospital of Fudan University, Shanghai. The study included 10 children （6 males, 4 females） aged between 13 days and 3 years at the time of their first procedure, with an average age of 7 months. Subglottic stenosis was graded according to the Myer-Cotton classification, with two cases classified as grade Ⅱ and eight cases as grade Ⅲ. All patients had a history of tracheal intubation, including seven for rescue purposes and three for operations. Eight cases were complicated by other conditions: two with atrial septal defect, patent ductus arteriosus, and patent foramen ovale; two with patent foramen ovale only; one with atrial septal defect and extreme deafness in the left ear; one with a brain tumor and hydrocephalus; one with a traumatic diaphragmatic hernia and hepatic rupture; and one case complicated by type Ⅰ laryngeal cleft. Prior to surgery, all children required respiratory support-seven needed high-flow oxygen while three required CPAP. All ten cases underwent endoscopic balloon dilation under spontaneous respiration and general anesthesia, totaling fourteen dilations （an average of 1.4 dilations per person） without any complications. Post-surgery air permeability tests showed that eight cases had grade Ⅰ stenosis while two had grade Ⅱ stenosis. The follow-up period ranged from six months to six years （average duration: 46 months）. Following treatment, all patients no longer required respiratory support or experienced significant mobility limitations. Endoscopic balloon dilation under general anesthesia is deemed safe and effective in treating secondary subglottic stenosis. Early diagnosis coupled with prompt intervention can help avoid tracheotomy procedures altogether. Standard tracheoscopy combined with breathability testing represents a crucial approach to assess normal airway diameter and effectively reduce or prevent secondary subglottic stenosis following re-intubation.
探讨儿童获得性声门下狭窄行内镜球囊扩张喉成形术（EBDL）的疗效。回顾性分析2017年1月至2024年1月在上海复旦大学附属儿科医院耳鼻咽喉头颈外科因继发性声门下狭窄接受内镜球囊扩张治疗的患者的临床资料。该研究纳入了10名儿童（6名男性，4名女性），首次手术时年龄在13天至3岁之间，平均年龄为7个月。声门下狭窄根据迈尔-科顿分类法分级，其中2例为Ⅱ级，8例为Ⅲ级。所有患者均有气管插管史，其中7例为抢救插管，3例为手术插管。8例合并其他疾病：2例合并房间隔缺损、动脉导管未闭和卵圆孔未闭；2例仅合并卵圆孔未闭；1例合并房间隔缺损和左耳极重度耳聋；1例合并脑肿瘤和脑积水；1例合并创伤性膈疝和肝破裂；1例合并Ⅰ型喉裂。术前，所有儿童均需要呼吸支持，7例需要高流量吸氧，3例需要持续气道正压通气（CPAP）。所有10例均在全身麻醉下自主呼吸下行内镜球囊扩张术，共进行14次扩张（平均每人1.4次），无任何并发症。术后透气试验显示，8例为Ⅰ级狭窄，2例为Ⅱ级狭窄。随访时间为6个月至6年（平均时长：46个月）。治疗后，所有患者均不再需要呼吸支持，也未出现明显的活动受限。全身麻醉下的内镜球囊扩张术在治疗继发性声门下狭窄方面被认为是安全有效的。早期诊断并及时干预可完全避免气管切开术。标准气管镜检查结合透气性测试是评估气道正常直径并有效减少或预防再次插管后继发性声门下狭窄的关键方法。
