Abstract：
BACKGROUND: Tracheobronchomalacia (TBM) and airway stenosis are recognized etiologies of airway obstruction among children. Their management is often challenging, requiring multiple interventions and prolonged respiratory support with associated long-term morbidity. Metallic or silicone stents have been used with mixed success and high complication rates. More recently biodegradable Ella stents (BES) provided an attractive interventional option.
OBJECTIVE: We report our experience in the treatment of TBM and vascular airway compression using BES. We deliberately downsized them to minimize intraluminal granulation tissue formation.
METHODS: Retrospective study over an 8-year period between November 2012 and December 2020 of pediatric patients with severe airway obstruction requiring airway stenting for extubation failure, malacic death spells, recurrent chest infections, or lung collapse.
RESULTS: Thirty-three patients (5 tracheal and 28 bronchial diseases) required 55 BES during the study period. The smallest patient weighed 1.8 kg. Median age of patient at first stent implantation was 13.1 months (IQR 4.9-58.3). The majority of the bronchial stents were in the left main bronchus (93%), of which 57% for vascular compression. Repeat stents were used in 19 patients (57.7%), with a range of two to four times. We did not experience erosion, infection, or obstructive granuloma needing removal by forceps or lasering. Three stent grid occluded with secretions needing bronchoscopic lavage. Stent migration occurred in three patients.
CONCLUSIONS: BES holds promise as a treatment option with low rate of adverse effects for a specific subset of pediatric patients with airway malacia or vascular compression. Further studies are warranted.
OBJECTIVE: We report our experience in the treatment of TBM and vascular airway compression using BES. We deliberately downsized them to minimize intraluminal granulation tissue formation.
METHODS: Retrospective study over an 8-year period between November 2012 and December 2020 of pediatric patients with severe airway obstruction requiring airway stenting for extubation failure, malacic death spells, recurrent chest infections, or lung collapse.
RESULTS: Thirty-three patients (5 tracheal and 28 bronchial diseases) required 55 BES during the study period. The smallest patient weighed 1.8 kg. Median age of patient at first stent implantation was 13.1 months (IQR 4.9-58.3). The majority of the bronchial stents were in the left main bronchus (93%), of which 57% for vascular compression. Repeat stents were used in 19 patients (57.7%), with a range of two to four times. We did not experience erosion, infection, or obstructive granuloma needing removal by forceps or lasering. Three stent grid occluded with secretions needing bronchoscopic lavage. Stent migration occurred in three patients.
CONCLUSIONS: BES holds promise as a treatment option with low rate of adverse effects for a specific subset of pediatric patients with airway malacia or vascular compression. Further studies are warranted.
摘要：
背景：气管支气管软化症（TBM）和气道狭窄是公认的儿童气道阻塞的病因。他们的管理往往具有挑战性，需要多种干预措施和长期呼吸支持与相关的长期发病率。金属或硅胶支架已被用于混合成功和高并发症发生率。最近可生物降解的Ella支架（BES）提供了一种有吸引力的介入选择。
目的：我们报告我们使用BES治疗TBM和血管气道压迫的经验。我们故意缩小它们的尺寸，以最大程度地减少管腔内肉芽组织的形成。
方法：在2012年11月至2020年12月之间的8年期间，回顾性研究患有严重气道阻塞需要气道支架置入治疗拔管失败的儿科患者，malacic死亡法术,复发性胸部感染，或者肺塌陷.
结果：33例患者（5例气管疾病和28例支气管疾病）在研究期间需要55BES。最小的患者体重为1.8公斤。首次支架植入患者的中位年龄为13.1个月(IQR4.9-58.3)。大多数支气管支架位于左主支气管（93％），其中57%用于血管压迫。19例患者（57.7%）使用重复支架，范围为两到四倍。我们没有经历侵蚀，感染,或阻塞性肉芽肿，需要用镊子或激光去除。三个支架网格堵塞，分泌物需要支气管镜灌洗。3例患者发生支架迁移。
结论：BES有望作为一种治疗选择，对于特定的亚组患有气道软化或血管压迫的儿科患者，其不良反应发生率较低。需要进一步的研究。
目的：我们报告我们使用BES治疗TBM和血管气道压迫的经验。我们故意缩小它们的尺寸，以最大程度地减少管腔内肉芽组织的形成。
方法：在2012年11月至2020年12月之间的8年期间，回顾性研究患有严重气道阻塞需要气道支架置入治疗拔管失败的儿科患者，malacic死亡法术,复发性胸部感染，或者肺塌陷.
结果：33例患者（5例气管疾病和28例支气管疾病）在研究期间需要55BES。最小的患者体重为1.8公斤。首次支架植入患者的中位年龄为13.1个月(IQR4.9-58.3)。大多数支气管支架位于左主支气管（93％），其中57%用于血管压迫。19例患者（57.7%）使用重复支架，范围为两到四倍。我们没有经历侵蚀，感染,或阻塞性肉芽肿，需要用镊子或激光去除。三个支架网格堵塞，分泌物需要支气管镜灌洗。3例患者发生支架迁移。
结论：BES有望作为一种治疗选择，对于特定的亚组患有气道软化或血管压迫的儿科患者，其不良反应发生率较低。需要进一步的研究。
