| Objective:To find out the etiologies and the clinical characteristics of laryngotracheal stenosis.It is rare that patients who suffered from juvenile-onset recurrent respiratory papillomatosis acquired laryngotracheal stenosis,and the optimal therapy for these patients was unknown.We aimed to determine therapeutic effect of laryngotracheal reconstruction surgery for these patients.Methods:246 patients diagnosed with laryngotracheal stenosis in our hospital from January 2016 to December 2017 were included,and the etiologies of the patients were reviewed.Laryngoscope,CT as well as laryngotracheal lateral X-ray radiographs were used to evaluate the stenosis site and degrees.The etiologies of laryngotracheal stenosis were classified and statistically compared.The stenosis sites and degrees of laryngeal stenosis caused by different etiologies were classified and compared.Records from 2008 to 2018 in our hospital were selected for reviewing if the patients were diagnosed juvenile-onset recurrent respiratory papillomatosis before laryngotracheal stenosis onset(24 patients).The decannulation rate and history of debulking surgery within6 months before laryngotracheal reconstruction were analyzed.Results:From January 2016 to December 2017,there were 246 patients,including 166 males,80 females,63 minors and 163 adults.Iatrogenic laryngotracheal stenosis occurred in 121cases(49.00%),trauma in 46 cases(19.00%),tumor surgery in 35 cases(14.00%),idiopathic disease in 26 cases(11.00%),autoimmune disease in 6 cases(2.40%),There were also 12 cases(7.00%)of stenosis caused by other rare diseases.There were 8 cases(3.24%)of supraglottic stenosis,69 cases(27.95%)of glottic stenosis,168 cases(68.02%)of supraglottic stenosis and 2 cases(0.79%)of supraglottic stenosis.The severity of subglottic stenosis is determined in Cotton-Myer grading system: gradeⅠaccounted for 0.90%,gradeⅡ accounted for 6.60%,grade Ⅲ accounted for 48.70% and grade Ⅳ accounted for43.80%.Of the 24 juvenile-onset recurrent respiratory papillomatosis patients,there were 14 males and 10 females,and all of them were minors.17 children(83.00%)achieved decannulation,including 3 patients delayed decannulation because of papillomatosis recurrences.4 patients(17.00%)underwent unsuccessful laryngotracheal reconstruction resulting from extremely serious papillomatosis recurrences.There are 4 cases(100.00%)in unsuccessful laryngotracheal reconstruction patients who underwent debulking surgery within recent 6 months before laryngotracheal reconstruction,and 5(25.00%)in decannulation patients.Conclusion:At present,endotracheal intubation,tracheotomy and other iatrogenic etiologies are the main causes of laryngotracheal stenosis.Patients with iatrogenic etiologies acquired more severe grade subglottic stenosis(grade III and IV).When diagnosed with juvenile-onset recurrent respiratory papillomatosis,the patient should be evaluated in detail before the laryngotracheal reconstruction.It is advisable for these patients to perform laryngotracheal reconstruction without history of debulking surgery within recent 6 months before laryngotracheal reconstruction. |
