目的:气道狭窄——尤其是多层次的——提出了复杂的管理挑战。这项研究评估了气管造口术的发生率,拔管,以及后声门狭窄(PGS)患者所需的手术数量,多级气道狭窄(MLAS),和双侧声带麻痹(BVFP)。
方法:确定了2016年至2021年在三个三级医疗中心接受治疗的气道狭窄患者。人口统计,狭窄的病因,医疗合并症,并收集患者报告的结果指标(PROM)。
结果:158名患者(84名女性,平均年龄56.98±15.5岁)被鉴定(54PGS,38MLAS,和66BVFP)。72.3%需要气管切开术,包括72.2%,86.8%,在这些组中占63.6%,分别。拔管率为43.6%,21.2%,在这些群体中,有32.5%,分别。MLAS患者气管切开率高于BVFP(p<0.05)。然而,两组拔管率无差异(p>0.05)。MLAS比PGS(2.4±2.2,p=0.02)或BVFP(1.0±1.8,p<0.0001)需要更多的手术(平均4.0±3.9)。最近一次随访的平均PROMs评分异常:15.4±12.2(呼吸困难指数),19.9±12.2(语音障碍指数-10),和9.67±11.1(饮食评估工具-10)。存在的合并症包括体重指数>30(41.4%),糖尿病(31.8%),肺部疾病(50.7%),胃食管反流病(39.4%),自身免疫性疾病(22.9%),和烟草使用史(55.2%)。
结论:气道狭窄是一个具有挑战性的临床问题,会对患者的生活质量产生负面影响,通常需要进行大量手术。与BVFP相比,PGS更频繁地需要气管造口术,但患者通常可以成功拔管。与单独声门狭窄相比,多级狭窄患者的脱管率较低,需要更多的手术;这些患者可能受益于更早和/或更积极的干预。
方法:4喉镜,133:528-534,2023年。
Airway stenosis-particularly multi-level-presents complex management challenges. This study assessed rates of tracheostomy, decannulation, and the number of surgeries required in patients with posterior glottic stenosis (PGS), multi-level airway stenosis (MLAS), and bilateral vocal fold paralysis (BVFP).
Airway stenosis patients treated between 2016 and 2021 at three tertiary medical centers were identified. Demographics, etiology of stenosis, medical comorbidities, and patient-reported outcome measures (PROMs) were collected.
158 patients (84 women, mean age 56.98 ± 15.5 years) were identified (54 PGS, 38 MLAS, and 66 BVFP). 72.3% required tracheostomy, including 72.2%, 86.8%, and 63.6% in these groups, respectively. Decannulation rates were 43.6%, 21.2%, and 32.5% in these groups, respectively. Patients with MLAS had higher rates of tracheostomy than BVFP (p < 0.05). However, decannulation rates were not different between groups (p > 0.05). MLAS required more surgeries (mean 4.0 ± 3.9) than PGS (2.4 ± 2.2, p = 0.02) or BVFP (1.0 ± 1.8, p < 0.0001). Mean PROMs scores at the latest follow-up were abnormal: 15.4 ± 12.2 (Dyspnea Index), 19.9 ± 12.2 (Voice Handicap Index-10), and 9.67 ± 11.1 (Eating Assessment Tool-10). Co-morbidities present included body mass index >30 (41.4%), diabetes (31.8%), pulmonary disease (50.7%), gastroesophageal reflux disease (39.4%), autoimmune disease (22.9%), and tobacco use history (55.2%).
Airway stenosis is a challenging clinical problem that negatively impacts patients\' quality of life and often requires numerous surgeries. PGS more frequently requires tracheostomy compared to BVFP, but patients can often decannulate successfully. Patients with multi-level stenosis have lower decannulation rates and require more surgeries than glottic stenosis alone; these patients may benefit from earlier and/or more aggressive intervention.
4 Laryngoscope, 133:528-534, 2023.