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刘 燕, 魏 萍, 寇 巍, 胡 思, 武 小, 刘 萌, 陈 成, 姚 红. [Analysis of clinical characteristics and surgical efficiency of severe laryngomalacia in children]. LIN CHUANG ER BI YAN HOU TOU JING WAI KE ZA ZHI = JOURNAL OF CLINICAL OTORHINOLARYNGOLOGY, HEAD, AND NECK SURGERY 2022; 36:258-264. [PMID: 35511616 PMCID: PMC10128184 DOI: 10.13201/j.issn.2096-7993.2022.04.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/27/2021] [Indexed: 06/14/2023]
Abstract
Objective:To analyze the clinical characteristics and factors affecting surgical efficiency in children with severe laryngomalacia. Methods:Retrospectively collect medical records of children with severe laryngomalacia who underwent supraglottoplasty in Children's Hospital of Chongqing Medical University between January 1, 2015 and May 1, 2019. And analyze the clinical characteristics, the improvement of main symptoms at different time points, and the influence factors on the surgical efficiency. Results:According to the anatomical classification of severe laryngomalacia, type Ⅳ accounted for the highest proportion(66.1%), and type Ⅰ was the lowest(3.6%). All children had stridor and dyspnea, 82.1% cases presented feeding difficulties, and 67.9% cases presented failure to thrive. The proportion of children with medical comorbidities was 62.5%, of which congenital heart disease had the highest incidence(39.3%) The surgical efficiency of severe laryngomalacia without comorbidities was 100.0%, with one type of comorbidity was 96.0%, with multiple comorbidities was 30.0%(P<0.01). Stridor, dyspnea, feeding difficulties were significantly improved at one month after surgery in most cases. In the group of surgical age less than 3 months, the surgical efficiency were 61.5%, 61.5% and 69.2% at 1, 3, 6 months after surgery, respectively; the surgical efficiency of children without comorbidities were 100.0%(P>0.05) at 1, 3 ,6 months after surgery. In the group of surgical age older than 3 months, the surgical efficiency of children were 100.0% at 1, 3, 6 months after surgery regardless with or without comorbidities. The surgical failure rate and reoperation rate in children without comorbidities was 0, but in the children with comorbidities were 22.9%(P<0.05) and 20.0%(P<0.05), respectively. The surgical failure rate and reoperation rate in children with multiple comorbidities was significantly higher than children with only one comorbidity(70.0% vs. 4.0%; 60.0% vs. 4.0%, P<0.01). The overall operation success rate was 85.7% in severe laryngomalacia children in our hospital. Conclusion:Most children with severe laryngomalacia are associated with multiple medical comorbidities, and with more complex anatomical types. Supraglottoplasty can effectively improve the symptoms in most children with severe laryngomalacia. The existence of multiple comorbidities is the main cause of surgical failure.
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Affiliation(s)
- 燕 刘
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 萍 魏
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 巍 寇
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 思洁 胡
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 小芳 武
- 重庆佑佑宝贝妇儿医院耳鼻咽喉科Department of Otorhinolaryngology, Chongqing Youyoubaobei Women's and Children's Hospital
| | - 萌雅 刘
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 成 陈
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
| | - 红兵 姚
- 重庆医科大学附属儿童医院耳鼻咽喉头颈外科 国家儿童健康与疾病临床医学研究中心 儿童发育疾病研究教育部重点实验室 儿科学重庆市重点实验室(重庆, 400014)Department of Otolaryngology Head and Neck Surgery, Children's Hospital of Chongqing Medical University, National Clinical Research Center for Child Health and Disorders, Ministry of Education Key Laboratory of Child Development and Disorders, Chongqing Key Laboratory of Pediatrics
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Sapundzhiev NR, Nikiforova LT, Stoyanov GS, Valkadinov I, Genova P, Platikanov V. Harmonic Shears in the Surgical Treatment of Laryngomalacia. Cureus 2019; 11:e5880. [PMID: 31772850 PMCID: PMC6837271 DOI: 10.7759/cureus.5880] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Introduction Laryngomalacia (LM) is a condition that is clinically diagnosed in the pediatric period with inspiratory stridor and is caused by a congenital or acquired collapse of laryngeal suprastructures. Endoscopic supraglottoplasty is the modern gold standard surgical treatment for severe or complicated laryngomalacia. Various cold and powered surgical devices have been used to approach the aryepiglottic folds, and their advantages and drawbacks have been widely discussed. The applicability of Ultracision Harmonic shears (Ethicon Inc., NJ, US) for the sake of supraglottoplasty has not been previously advocated in the literature and is the subject of this study. Methods This was a review of the medical records of pediatric patients, with moderate to severe congenital laryngomalacia, who underwent supraglottoplasty with Harmonic at a single institution, from 2013 to 2019. Results A total of six patients underwent bilateral aryepiglottic fold division with the use of Ultracision in the study period (4 male, 2 female; mean age 7+/-9 months, age range 1m-24m). Postoperatively, all of the children were extubated and admitted to the pediatric intensive care unit (PICU) as a precaution measure. There were no early or late complications after the intervention. The postoperative endoscopic picture was evaluated in three patients (two of which for another reason). A stable laryngeal frame with no collapse or excessive scarring was observed. None of the patients required repeat surgery. Conclusion Based on the ease of surgical access, performance, surgical precision, and postoperative results, the use of Harmonic scissors appears to be a safe, practical, affordable, and easily applicable alternative for supraglottoplasty Type 2.
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Affiliation(s)
| | | | - George S Stoyanov
- General and Clinical Pathology, Forensic Medicine and Deontology, Medical University of Varna, Varna, BGR
| | | | - Petya Genova
- Otolaryngology, Medical University of Varna, Varna, BGR
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