Outcome of a Multimodality Approach to the Management of Idiopathic Subglottic Stenosis
Outcome of a Multimodality Approach to the Management of Idiopathic Subglottic Stenosis
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DOI：
10.1002/lary.23949
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发表时间：
2013-10-01
期刊：
影响因子：
2.6
通讯作者：
Sandhu, G. S.
中科院分区：
文献类型：
--
作者：
Nouraei, S. A. R.;Sandhu, G. S.
目的/假设评估特发性声门下狭窄（ISS）的治疗效果，确定治疗成功和结果的预测因素，并更好地定义内窥镜和开放手术的作用和局限性。研究设计前瞻性观察性研究。方法2004 ~ 2012年连续治疗54例患者。记录患者、狭窄和治疗细节、并发症、开放手术率和结果。回归分析用于确定内镜治疗成功的预测因素；治疗频率;以及气道，呼吸困难，声音和吞咽功能的结果。结果所有患者均为女性，确诊时平均年龄4812岁。从症状到诊断潜伏期为2120个月。伴有声门及声门下狭窄10例。大多数病变为Myer-Cotton 3级（48%）。总体而言，78%的患者接受了内窥镜检查。治疗方法包括病灶内皮质类固醇、激光手术、球囊扩张和临时橡胶支架置入术。年干预率为1.07±0.79。平均随访时间为45个月。与干预频率相关的因素是狭窄的位置和严重程度。12例患者在生物抑制下行前后喉气管重建。这导致所有声门下狭窄患者以及大多数合并声门和声门下狭窄患者的疾病缓解。全喉气管狭窄患者需要持续治疗声门疾病。所有患者均维持无假体气道，但有一位患者需要进行喉切除术。大多数患者获得了良好的功能预后。狭窄位置是呼吸困难和语音预后的唯一独立预测因子。结论内窥镜手术或定制的开放重建手术可以有效地治疗鼻窦炎，且不影响女性语音质量。证据水平喉镜，23 (3):774 - 784,2013
Objectives/HypothesisTo assess the results of treating idiopathic subglottic stenosis (ISS), determine predictors of treatment success and outcome, and better define roles and limitations of endoscopic and open surgery.Study DesignProspective observational study.MethodsFifty-four consecutive patients were treated between 2004 and 2012. Patient, stenosis and treatment details, complications, open surgery rates, and outcomes were recorded. Regression analyses were used to identify predictors of endoscopic treatment success; treatment frequency; and functional outcomes in airway, dyspnea, voice, and swallowing domains.ResultsAll patients were female and mean age at diagnosis was 48 12 years. Symptoms-to-diagnosis latency was 2120 months. There were 10 concomitant glottic and subglottic stenoses. Most lesions were Myer-Cotton grade 3 (48%). Overall, 78% of patients were managed endoscopically. Treatment included intralesional corticosteroids, laser surgery, balloon dilation, and temporary silastic stenting in selected cases. Annual intervention rate was 1.07 +/- 0.79. Mean follow-up was 45 months. Factors associated with intervention frequency were stenosis location and severity. Twelve patients underwent anteroposterior laryngotracheal reconstruction with biological inhibition. This resulted in disease remission in all patients with subglottic stenosis, and in most patients with concomitant glottic and subglottic stenosis. Patients with total laryngotracheal stenosis required ongoing treatment for glottic disease. All patients maintained prosthesis-free airways, but in one patient this required a laryngectomy. Most patients achieved good functional outcomes. Stenosis location was the only independent predictor of dyspnea and voice outcomes.ConclusionsISS can be effectively treated with endoscopic surgery or a bespoke open reconstructive procedure that does not compromise on female voice quality.Level of Evidence4. Laryngoscope, 123:2474-2484, 2013