Abstract：
OBJECTIVE: Endoscopic balloon dilatation (EBD) offers a safe and non-invasive surgical option for the treatment of subglottic stenosis. Patient selection is important to achieve good results and to detect which patients are more prone to the development of complications. The aim of this study was to determine predictors of postoperative problems and early complications in primary EBD surgeries.
METHODS: A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis.
RESULTS: The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 ± 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 ± 15.21%, mean DPI was 25.25 ± 35.49 days, and mean EDT was calculated as 78.23 ± 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications.
CONCLUSIONS: EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.
METHODS: A retrospective analysis was made of patients with acquired subglottic stenosis who were operated on with the EBD technique between January 2010 and December 2019 in the Otolaryngology-Head and Neck Surgery Department of Baskent University Hospital. Demographic data including the age and sex of the patients were collected together with etiology, presence of chromosomal or craniofacial anomaly (C/CA), duration of prolonged intubation (DPI), and extubation dilatation timeframe (EDT). Intra and postoperative follow-up data were recorded of the need for intubation or tracheotomy, development of desaturation, and grade and type of stenosis.
RESULTS: The male to female ratio was 2:1. The patients comprised 42 males and 22 females with a mean age of 296.52 ± 551.93 days. The cause of prolonged intubation was surgery for congenital heart disease in 50 (78.1%) patients and prematurity in 14 (21.9%). The type of lesion was acute granulation in 44 (72.1%) and chronic granulation in 17 (27.9%) patients. C/CA was determined in 13 patients, the mean grade of stenosis was 76.33 ± 15.21%, mean DPI was 25.25 ± 35.49 days, and mean EDT was calculated as 78.23 ± 373.82 days. Desaturation following endoscopic balloon dilatation developed in 26 (40.6%), orotracheal intubation was required in 10 (15.6%), tracheotomy in 10 (15.6%), and cardiopulmonary arrest occurred in 4 (6.25%). Prematurity, a longer duration of preoperative intubation, longer time from extubation to dilatation, older age, and higher grade of stenosis were determined as factors associated with postoperative early respiratory complications.
CONCLUSIONS: EBD indication should be carefully considered in children with acquired subglottic stenosis. To achieve better results and minimise complications, EBD should be performed without delay.
摘要：
目的：内镜下球囊扩张术（EBD）为声门下狭窄的治疗提供了一种安全且无创的手术选择。患者选择对于取得良好的结果以及检测哪些患者更容易发生并发症很重要。这项研究的目的是确定原发性EBD手术中术后问题和早期并发症的预测因素。
方法：回顾性分析2010年1月至2019年12月在巴斯肯特大学医院耳鼻咽喉头颈外科行EBD手术的获得性声门下狭窄患者。收集了包括患者年龄和性别在内的人口统计学数据以及病因，染色体或颅面异常（C/CA）的存在，长时间插管（DPI）的持续时间，和拔管扩张时间框架（EDT）。记录术中和术后随访数据，是否需要插管或气管切开术，去饱和的发展，狭窄的级别和类型。
结果：男女比例为2:1。患者包括42名男性和22名女性，平均年龄为296.52±551.93天。长时间插管的原因是50例（78.1％）先天性心脏病患者的手术和14例（21.9％）的早产。病变类型为急性肉芽44例（72.1％），慢性肉芽17例（27.9％）。在13例患者中确定了C/CA，狭窄的平均级别为76.33±15.21%，平均DPI为25.25±35.49天，平均EDT计算为78.23±373.82天。26例（40.6%）发生内窥镜球囊扩张后的去饱和，10例（15.6%）需要经气管插管，气管切开术10例（15.6%），4例(6.25%)发生心肺骤停。早产,术前插管持续时间较长，从拔管到扩张的时间更长，年龄较大,和更高的狭窄程度被确定为与术后早期呼吸系统并发症相关的因素。
结论：儿童获得性声门下狭窄应仔细考虑EBD指征。为了获得更好的结果并最大限度地减少并发症，EBD应毫不拖延地进行。
方法：回顾性分析2010年1月至2019年12月在巴斯肯特大学医院耳鼻咽喉头颈外科行EBD手术的获得性声门下狭窄患者。收集了包括患者年龄和性别在内的人口统计学数据以及病因，染色体或颅面异常（C/CA）的存在，长时间插管（DPI）的持续时间，和拔管扩张时间框架（EDT）。记录术中和术后随访数据，是否需要插管或气管切开术，去饱和的发展，狭窄的级别和类型。
结果：男女比例为2:1。患者包括42名男性和22名女性，平均年龄为296.52±551.93天。长时间插管的原因是50例（78.1％）先天性心脏病患者的手术和14例（21.9％）的早产。病变类型为急性肉芽44例（72.1％），慢性肉芽17例（27.9％）。在13例患者中确定了C/CA，狭窄的平均级别为76.33±15.21%，平均DPI为25.25±35.49天，平均EDT计算为78.23±373.82天。26例（40.6%）发生内窥镜球囊扩张后的去饱和，10例（15.6%）需要经气管插管，气管切开术10例（15.6%），4例(6.25%)发生心肺骤停。早产,术前插管持续时间较长，从拔管到扩张的时间更长，年龄较大,和更高的狭窄程度被确定为与术后早期呼吸系统并发症相关的因素。
结论：儿童获得性声门下狭窄应仔细考虑EBD指征。为了获得更好的结果并最大限度地减少并发症，EBD应毫不拖延地进行。
