성문하 협착 소아 환자에 대한 내시경적 기도 확장 시술 후 치료 실패 위험 요인 분석
Risk Factor Analysis of Endoscopic Dilation Procedure for the Management of Subglottic Stenosis in Pediatric Patients
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
Background and Objective: Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods: This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results: The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion: Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.
Abstract
Background and Objective: Endoscopic airway dilation is the primary treatment for pediatric subglottic stenosis (SGS) due to its feasibility and non-invasiveness. The aim of this study is to evaluate the risk factors for the failure of endoscopic airway dilation in pediatric patients with SGS. Materials and Methods: This study reviewed medical records of 38 pediatric patients had endoscopic dilation from a single and tertiary referral center, retrospectively. The success of the endoscopic dilation procedure was defined as no dyspneic symptom without tracheostomy or laryngotracheal reconstruction. Demographic profiles, underlying disease, and Myer-Cotton SGS severity grade were recorded. Success rates and risk factors for the failure of treatment were analyzed. Results: The SGS patients with severity grade I was most common. After mean 1.8 numbers of procedures, there were 23 patients (60.5%) in the success group and 15 patients (39.5%) in the failure group. Age, sex, underlying diseases, and SGS severity grade were not significantly different between two groups. In patients who had multiple endoscopic procedures, the failure group showed SGS deteriorated after procedures in 66.7%, compared to 11.1% of the success group. In multivariable analysis, a long-term intubation (≥1 month) was identified as an independent risk factor for failure of endoscopic dilation procedure. Conclusion: Although endoscopic dilation procedure is safe and effective for the management, repetitive endoscopic dilation may not give clinical benefit in patient with long-term intubation. Other airway procedures must be considered in those group of patients.
참고문헌 (15)
- Hartnick CJ, "Surgery for pediatric subglottic stenosis : disease-specific outcomes", Ann Otol Rhinol Laryngol, 110(12), pp.1109~1113 (2001)
- Lang M, "A systematic review and meta-analysis of endoscopic balloon dilation of pediatric subglottic stenosis", Otolaryngol Head Neck Surg, 150(2), pp.174~179 (2014)
- Quesnel AM, "Minimally invasive endoscopic management of subglottic stenosis in children : success and failure", Int J Pediatr Otorhinolaryngol, 75(5), pp.652~656 (2011)
- Hautefort C, "Balloon dilation laryngoplasty for subglottic stenosis in children : eight years’ experience", Arch Otolaryngol Head Neck Surg, 138(3), pp.235~240 (2012)
- Myer CM 3rd, "Proposed grading system for subglottic stenosis based on endotracheal tube sizes", Ann Otol Rhinol Laryngol, 103(4 Pt 1), pp.319~323 (1994)
- Rodríguez H, "Post-intubation subglottic stenosis in children. Diagnosis, treatment and prevention of moderate and severe stenosis", Acta Otorrinolaringol Esp, 64(5), pp.339~334 (2013)
- Whigham AS, "Outcomes of balloon dilation in pediatric subglottic stenosis", Ann Otol Rhinol Laryngol, 121(7), pp.442~448 (2012)
- 오솔길, "Long-Term Results of Endoscopic Dilatation for Tracheal and Subglottic Stenosis", Clinical and Experimental Otorhinolaryngology, 7(4), pp.324~328 (2014), 대한이비인후과학회[DOI]
- Maresh A, "A comparative analysis of open surgery vs endoscopic balloon dilation for pediatric subglottic stenosis", JAMA Otolaryngol Head Neck Surg, 140(10), pp.901~905 (2014)
- Avelino M, "Predicting outcomes of balloon laryngoplasty in children with subglottic stenosis", Int J Pediatr Otorhinolaryngol, 79(4), pp.532~536 (2015)
- Benjamin B, "Prolonged intubation injuries of the larynx : endoscopic diagnosis, classification, and treatment", Ann Otol Rhinol Laryngol, 127(8), pp.492~507 (2018)
- Duynstee ML, "Subglottic stenosis after endolaryngeal intubation in infants and children : result of wound healing processes", Int J Pediatr Otorhinolaryngol, 62(1), pp.1~9 (2002)
- Cakir E, "Post-intubation subglottic stenosis in children : analysis of clinical features and risk factors", Pediatr Int, 62(3), pp.386~389 (2020)
- Smith ME, "Mitomycin C and the endoscopic treatment of laryngotracheal stenosis : are two applications better than one?", Laryngoscope, 119(2), pp.272~283 (2009)
- Warner D, "Mitomycin C and airway surgery: how well does it work?", Otolaryngol Head Neck Surg, 138(6), pp.700~709 (2008)