儿童声门下狭窄的内镜治疗：哥伦比亚一家转诊中心频繁扩张方案的影响
Endoscopic management of pediatric subglottic stenosis: Impact of a frequent dilation regimen at a referral center in Colombia.
文献信息
| PMID | 42815566 |
|---|---|
| 原文 | 在 PubMed 查看原文 ↗ |
| 发表日期 | 2026 |
| 作者 | Katherin Andrea Borda Pedraza |
| 作者单位 | Facultad de Medicina, Universidad Nacional de Colombia, Bogotá, Colombia. Electronic address: kabordap@unal.edu.co. |
| 期刊 | Acta otorrinolaringologica espanola |
| SCI 分区 | Q3 |
| IF | 1.1 |
| 研究类型 | 临床研究 · 临床 |
| 所属专科 | 咽喉科 |
中文摘要
引言与目的： 儿童声门下狭窄（SGS）是长期插管的严重并发症。对于内镜下扩张的最佳间隔时间尚无共识。本研究报道延迟扩张（DD）与频繁扩张（FD）的临床结局。
材料与方法： 在三级儿童医院（2009-2022年）进行的回顾性队列研究。我们纳入190例SGS患者，分为历史队列：DD组（2009-2018年，n=140）和FD组（2019-2022年，n=50）。主要结局是治疗失败，定义为需要>5次扩张、气管切开或喉气管重建（LTR）。
结果： DD组扩张之间的中位间隔为38.5天（IQR 28-52），FD组为27.5天（IQR 4-40）（p<0.01）。DD组失败率更高：>5次扩张（12.1% vs 0%；p=0.01）、气管切开（29.3% vs 22.0%；p=0.31）和LTR（8.6% vs 4.0%；p=0.36）。辅助治疗使用率高且安全（0%不良事件）。FD组中丝裂霉素C的使用从75.6%增加到89.6%，曲安奈德从88.3%增加到90.9%。需要>5次扩张与需要手术强烈相关（p=0.00049）。
结论： 频繁扩张（FD）方案与较低的多重手术需求相关，并有气管切开和LTR率降低的趋势。辅助治疗使用增加且安全性良好，提示其在改善结局中可能起补充作用。
英文摘要
INTRODUCTION AND OBJECTIVE: Pediatric subglottic stenosis (SGS) is a serious complication of prolonged intubation. There is no consensus on the optimal interval between endoscopic dilatations. This study reports the clinical outcomes of deferred dilation (DD) versus frequent dilation (FD).
MATERIAL AND METHOD: Retrospective cohort study in a tertiary pediatric hospital (2009-2022). We included 190 patients with SGS divided into historical cohorts: DD group (2009-2018, n = 140) and FD group (2019-2022, n = 50). The primary outcome was therapeutic failure, defined as the need for >5 dilatations, tracheostomy, or laryngotracheal reconstruction (LTR).
RESULTS: The median interval between dilatations was 38.5 days (IQR 28-52) in the DD group and 27.5 days (IQR 4-40) in the FD group (p < 0.01). Failure rates were higher in the DD group: >5 dilatations (12.1% vs 0%; p = 0.01), tracheostomy (29.3% vs 22.0%; p = 0.31), and LTR (8.6% vs 4.0%; p = 0.36). Adjuvant use was high and safe (0% adverse events). The use of mitomycin C increased from 75.6% to 89.6% and triamcinolone from 88.3% to 90.9% in the FD group. The need for >5 dilatations was strongly associated with the need for surgery (p = 0.00049).
CONCLUSIONS: The frequent dilation (FD) regimen was associated with a lower need for multiple procedures and a trend towards lower rates of tracheostomy and LTR. The increased use of adjuvants, with a favorable safety profile, suggests a complementary role in improving outcomes.