Die Chirurgie der erworbenen laryngotrachealen Stenosen im Kindesalter. Erfahrungen und Ergebnisse von 1988-1998

Abstract

Approximately 90% of infants and children with severe acquired laryngotracheal stenoses are tracheotomy dependent and therefore impaired in their physical and speech developments. In addition, tracheotomized infants can be endangered by the cannula due to the possible crusting of secretions or its dislocation. Thus, early repair of a stenosis is mandatory. Within the last 10 years, we successfully operated on 18 children with severe laryngotracheal stenoses. Ten children were treated with a modified Cotton technique. This paper reports our results of cricotracheal resection performed in 8 children since 1994 (age distribution: 7 months through age 15 years). Four children had Cotton grade II stenoses, three had grade III stenoses and one grade IV stenoses. In 3 patients a tracheotomy had been performed at another institution. Since their tracheostomas were too far caudal, they could not be included in the primary resection. All 8 children have been successfully decannulated. Five children without tracheotomies could be extubated uneventfully on the 5th postoperative day. All three primarily tracheotomized children needed further endotracheal stenting with T-tubes because of stomal and suprastomal collapse. Two of these latter children additionally required a tracheoplasty with rib cartilage grafts in order to stabilize the suprastomal trachea prior to decannulation. No patient experienced injuries to the recurrent laryngeal nerves or insufficiencies of the anastomosis. All children's voices were not impaired. This is the third report in literature of cricotracheal resections in infants and children, indicating that this effective, one-stage procedure is superior to laryngotracheal reconstruction with rib cartilage.

Partial cricotracheal resection for pediatric subglottic stenosis: a single institution's experience in 60 cases.

“…The respective indications of PCTR and LTR have been a matter of debate over the last years, but it is now generally accepted that PCTR represents the treatment of choice for severe grade III and IV SGS without glottic involvement as a primary or salvage surgery [5,6,7,8].…”

Management von Postintubationsstenosen bei Kindern

“…Nach der Operation werden die Kinder auf die pädiat-rische Intensivstation verlegt und dort 5-7 Tage lang artifiziell beatmet [16]. In jüngster Zeit versuchen manche Autoren, die Intubationszeit auch nach laryngotrachealer Rekonstruktion auf 24-48 h zu kürzen, was offenbar möglich ist [35].…”

“…Dann erfolgt die Extubation unter endoskopischer Sicht und bei regelrechten Wundverhältnissen eine Reintubation mit einem um eine Nummer kleineren Tubus für weitere 24 h.Danach wird endgültig extubiert unter Fortsetzung der Glukokortikoid-und Antirefluxbehandlung [18].Vollrath extubiert bereits am 5.postoperativen Tag und überwacht die Kinder ohne Reintubation weitere 4 Tage lang intensiv [36]. Da sich nach der endgültigen Extubation relativ rasch Granulationen bilden können,ist entweder bei Auftreten eines Belastungsstridors oder nach spätestens 7 Tagen eine weitere endoskopische Untersuchung erforderlich.…”

Endotracheale Silikonstents im Therapiemanagement benigner Trachealstenosen

“…Die unterschiedlichen Erfolgsraten der einzelnen Techniken sind in zahlreichen Studien belegt [10,14,18,19,20]. Die unterschiedlichen Erfolgsraten der einzelnen Techniken sind in zahlreichen Studien belegt [10,14,18,19,20].…”