Balloon laryngoplasty for acquired subglottic stenosis in children: predictive factors for success

INTRODUCTION: The treatment of subglottic stenosis in children remains a challenge for the otorhinolaryngologist, and may involve both endoscopic and open surgery. OBJECTIVE: To report the experience of two tertiary facilities in the treatment of acquired subglottic stenosis in children with balloon laryngoplasty, and to identify predictive factors for success of the technique and its complications. METHODS: Descriptive, prospective study of children diagnosed with acquired subglottic stenosis and submitted to balloon laryngoplasty as primary treatment. RESULTS: Balloon laryngoplasty was performed in 37 children with an average age of 22.5 months; 24 presented chronic subglottic stenosis and 13 acute subglottic stenosis. Success rates were 100% for acute subglottic stenosis and 32% for chronic subglottic stenosis. Success was significantly associated with acute stenosis, initial grade of stenosis, children of a smaller age, and the absence of tracheostomy. Transitory dysphagia was the only complication observed in three children. CONCLUSION: Balloon laryngoplasty may be considered the first line of treatment for acquired subglottic stenosis. In acute cases, the success rate is 100%, and although the results are less promising in chronic cases, complications are not significant and the possibility of open surgery remains without prejudice.

引言：儿童声门下狭窄（subglottic stenosis）的治疗仍是耳鼻咽喉科医师（otorhinolaryngologist）面临的临床挑战，其治疗手段可同时涵盖内镜手术与开放手术。
研究目的：本研究旨在报告两家三级医疗机构应用球囊喉成形术（balloon laryngoplasty）治疗儿童获得性声门下狭窄的临床经验，并明确该技术成功的预测因素及其相关并发症的影响因素。
研究方法：本研究为描述性前瞻性研究，纳入确诊为获得性声门下狭窄且以球囊喉成形术作为初始治疗方案的儿童患者。
研究结果：本研究共纳入37例接受球囊喉成形术的患儿，平均年龄为22.5月龄；其中24例为慢性声门下狭窄，13例为急性声门下狭窄。急性声门下狭窄患者的治疗成功率为100%，慢性患者为32%。治疗成功与狭窄类型为急性、初始狭窄分级、患儿年龄较小以及未行气管切开术（tracheostomy）显著相关。本研究仅观察到3例患儿出现一过性吞咽困难（transitory dysphagia）这一并发症。
研究结论：球囊喉成形术可作为儿童获得性声门下狭窄的一线治疗方案。对于急性病例，其治疗成功率可达100%；尽管慢性病例的治疗效果欠佳，但并发症发生率较低，且不会妨碍后续开放手术的实施。