Mohammed A Awadh, Abdulsalam Alqutub, Mohammad A Alzahrani, Naif Mozahim, Sarah M AlSharif, Abeer Z Malebari, Talal Al-Khatib
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引用次数: 0
Abstract
Background: Laryngotracheal stenosis (LTS) results from abnormal airway narrowing, primarily caused by iatrogenic injuries like prolonged intubation. It leads to respiratory distress and vocal complications, requiring interventions ranging from endoscopic procedures to open surgeries like laryngotracheal reconstruction (LTR) with autologous grafts. Pediatric patients pose unique challenges due to smaller airways but may have better healing outcomes. This review aims to synthesize evidence on the success and operative parameters of different grafts in pediatric LTR to guide clinical decision-making and improve patient outcomes.
Methods: We retrieved relevant articles from PubMed, Scopus, Web of Science, and the Cochrane Library up to August 2024. Two independent authors extracted data from eligible studies, including baseline information, success rate, need for extra procedures, time to stent removal, and time to decannulation. All analyses were undertaken using RevMan v5.4.
Results: We collected 1,201 records from four databases after excluding 788 duplicates. After screening titles and abstracts, 108 records were assessed for eligibility, resulting in 86 included articles. Of these, 64 had enough data for analysis. The overall success rate for LTR was 89% for costal grafts, 86% for thyroid grafts, and 85% for auricular grafts, with no significant differences between graft types. A third of cases required additional procedures. Time to stent removal averaged 7.85 days for single-stage LTR and 62.86 days for double-stage LTR. Decannulation took 198.29 days. Complications included respiratory issues like atelectasis and pneumonia, graft-related problems, infections, and wound complications. Donor site complications and deaths were rare but occurred due to respiratory arrest, pneumothorax, and tracheotomy tube obstruction.
Conclusion: Costal, thyroid, and auricular grafts are comparable and show similar success rates in pediatric LTR. Optimizing perioperative management is crucial for reducing complications. Future research should standardize postoperative care and address patient pathology heterogeneity to improve outcomes.
背景:喉气管狭窄(LTS)是气道异常狭窄的结果,主要由医源性损伤如插管时间延长引起。它会导致呼吸窘迫和声带并发症,需要从内窥镜手术到开放性手术,如自体移植喉气管重建(LTR)等多种干预措施。儿科患者由于气道较小而面临独特的挑战,但可能有更好的愈合结果。本综述旨在综合小儿LTR中不同移植物的成功和手术参数的证据,以指导临床决策和改善患者预后。方法:检索PubMed、Scopus、Web of Science和Cochrane Library截至2024年8月的相关文章。两位独立作者从符合条件的研究中提取数据,包括基线信息、成功率、需要额外的手术、支架取出时间和去管时间。所有分析均使用RevMan v5.4进行。结果:我们从4个数据库中收集了1,201条记录,排除了788条重复。在筛选标题和摘要后,对108篇记录进行了合格性评估,产生86篇纳入文章。其中,64个有足够的数据进行分析。肋部移植物LTR的总成功率为89%,甲状腺移植物为86%,耳部移植物为85%,移植物类型之间无显著差异。三分之一的病例需要额外的程序。单期LTR平均支架取出时间为7.85天,双期LTR平均支架取出时间为62.86天,脱管时间为198.29天。并发症包括呼吸系统问题,如肺不张和肺炎,移植物相关问题,感染和伤口并发症。供体部位并发症和死亡是罕见的,但发生呼吸停止,气胸,气管切开管阻塞。结论:肋、甲状腺和耳廓移植在儿童LTR中具有可同性和相似的成功率,优化围手术期管理是减少并发症的关键。未来的研究应规范术后护理,解决患者病理异质性,以改善预后。
期刊介绍:
Official Journal of
European Union of Medical Specialists – ORL Section and Board
Official Journal of Confederation of European Oto-Rhino-Laryngology Head and Neck Surgery
"European Archives of Oto-Rhino-Laryngology" publishes original clinical reports and clinically relevant experimental studies, as well as short communications presenting new results of special interest. With peer review by a respected international editorial board and prompt English-language publication, the journal provides rapid dissemination of information by authors from around the world. This particular feature makes it the journal of choice for readers who want to be informed about the continuing state of the art concerning basic sciences and the diagnosis and management of diseases of the head and neck on an international level.
European Archives of Oto-Rhino-Laryngology was founded in 1864 as "Archiv für Ohrenheilkunde" by A. von Tröltsch, A. Politzer and H. Schwartze.