[Treatment by CO2 broncho-laser for acquired tracheobronchial stenosis in children with bronchopulmonary dysplasia].

OBJECTIVE

Evaluation of carbon dioxide (CO2) broncholaser for treating acquired proximal tracheo-bronchial stenosis in children with bronchopulmonary dysplasia.

DESIGN

Retrospective study from June 1987 through August 1995, with 39 months follow-up.

PATIENTS AND METHODS

During the study, 65 children were treated for bronchopulmonary dysplasia. Eight of those (average age: 42.6 months) had symptomatic tracheo-bronchial stenosis; they were treated with CO2 broncholaser and represented 23.5% of all broncholaser applications. All patients presented multiple lesions. Ten symptomatic well-organized lesions (obstructive bridles or diaphragms), all accessible to broncholaser, were treated. Broncholaser was the primary treatment used, except in one case where it was used following balloon dilatation failure. An adaptable rigid fibroscope combined with a CO2 Sharplan laser was used. All interventions were performed under general anesthesia.

RESULTS

Lesions not reaching the trachea's bifurcation (eight cases) disappeared following one laser session with significant clinical improvement. Lesions extending to the trachea's bifurcation (two cases) only showed partial improvement despite three laser sessions. The results remained stable throughout the follow-up period. There were no major complications.

CONCLUSIONS

Broncholaser is a safe and efficient method of treating stenoses occurring in patients with bronchopulmonary dysplasias. Obstructive lesions (such as bridles or diaphragms) and those which do not reach the trachea's bifurcation, give the best results.