儿科气管切开术后造口上塌陷的患病率、相关性和结局

IF 1.7 4区医学 Q2 OTORHINOLARYNGOLOGY

Laryngoscope Investigative Otolaryngology Pub Date : 2025-08-21 DOI:10.1002/lio2.70245

Ashley Young, Alexander Szymczak, Taher Valika, Saied Ghadersohi, Inbal Hazkani

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引用次数: 0

摘要

背景：口上塌陷是儿童气管切开术后的一种未被充分研究的后遗症，它可能会阻碍脱管。本研究旨在探讨小儿气管切开术后口上塌陷的患病率及相关危险因素。方法对2012年1月至2022年12月在某三级儿童医院行气管切开术的患儿进行回顾性队列研究。结果255例患儿行气管切开术，其中146例（57.3%）在切开术后10.7±12.6个月发生口上塌陷。气管切开术时年龄小于6个月的患者发生口上塌陷的可能性是其他患者的两倍（OR = 2.07, p = 0.0059）。直接喉镜检查和支气管镜检查结果与塌陷几率增加相关的包括气管支气管软化（OR = 1.72, p = 0.029）、声门下狭窄（OR = 2.96, p = 0.000028）、声门或声门下水肿（OR = 2.4, p = 0.0012）。口周肉芽组织的存在和这种组织的手术切除与口上塌陷的发生没有显著的关系。在log-rank分析中，接受肉芽组织切除的患者发生塌陷的中位时间明显长于未接受肉芽组织切除的患者（8.2个月对4.8个月，p = 0.003）。有口上塌陷的患者比没有塌陷的患者更有可能需要上气道手术（OR 2.1, 95% CI 1.16-3.83, p = 0.0125）或喉气管重建（OR 3.4, 95% CI 1.41-9.64, p = 0.006）。结论：在我们的队列中，60%的患者发生了口上塌陷，并与气道重建的需要有关。影响因素包括气管造口术年龄、气管支气管软化、声门下狭窄、声门和声门下水肿。尽管担心削弱气管软骨，但肉芽组织切除与塌陷的发展无关。证据级别4。

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Prevalence, Associations, and Outcomes of Suprastomal Collapse After Pediatric Tracheostomy

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Prevalence, Associations, and Outcomes of Suprastomal Collapse After Pediatric Tracheostomy

Background

Suprastomal collapse is an understudied sequela of pediatric tracheostomy that may hinder decannulation. This study aims to investigate the prevalence and associated risk factors of suprastomal collapse following pediatric tracheostomy.

Methods

A retrospective cohort study of children who underwent tracheostomy at a tertiary-care children's hospital between 1/2012 and 12/2022.

Results

A total of 255 children underwent tracheostomy, with 146 (57.3%) developing suprastomal collapse 10.7 ± 12.6 months after the tracheostomy. Patients younger than 6 months at the time of tracheostomy were twice as likely to develop suprastomal collapse (OR = 2.07, p = 0.0059). Direct laryngoscopy and bronchoscopy findings associated with increased odds of collapse included tracheobronchomalacia (OR = 1.72, p = 0.029), subglottic stenosis (OR = 2.96, p = 0.000028), and glottic or subglottic edema (OR = 2.4, p = 0.0012). The presence of peristomal granulation tissue and the surgical removal of this tissue were not significantly associated with the development of suprastomal collapse. On log-rank analysis, the median time to develop collapse was significantly longer in patients who underwent granulation tissue removal compared to those who did not (8.2 vs. 4.8 months, p = 0.003). Patients with suprastomal collapse were significantly more likely to require upper airway surgery (OR 2.1, 95% CI 1.16–3.83, p = 0.0125) or laryngotracheal reconstruction (OR 3.4, 95% CI 1.41–9.64, p = 0.006) than those without collapse.

Conclusions

Suprastomal collapse occurred in 60% of our cohort and was associated with the need for airway reconstruction. Contributing factors included age at tracheostomy, tracheobronchomalacia, subglottic stenosis, and glottic and subglottic edema. Despite concerns about weakening tracheal cartilage, granulation tissue removal was not associated with the development of collapse.