- The use of stents to restore airway patency in children
The use of stents to restore airway patency in children
Paediatric Surgery.2017.3(56):44-53; doi 10.15574/PS.2017.56.44
Krivchenya D. U., Dubrovin A. G., Rudenko E. O.
Bogomolets National Medical University, Kyiv, Ukraine
Objective. To determine the role of the stenting method in restoring of airway patency in children with airway stenoses of various origins.
Material and methods. The treatment outcomes in 11 patients aged 2 months to 10 years (16.8±9.1 months) with different variants of airway stenosis with the use of stents (n=12) were analyzed. The airway obstruction was caused by subglottic stenosis (n=3), complete cartilaginous tracheal rings (n=3), tracheomalacia (n=4), compression stenosis of the left main bronchus (n=2). Associated anomalies were detected in 3 (33.3%) patients: right lung agenesis, ventricular septal defect, complete cartilaginous tracheal rings (n=1); complete atrio-ventricular canal, coarctation of the aorta, compression stenosis of the left main bronchus (n=1); idiopathic scoliosis of the thoracic spine, residual pectus excavatum, compression stenosis of the left main bronchus (n=1). Three patients were premature with a gestation of 27, 33 and 34 weeks. Indications for stenting considered as follows: a very high risk of radical surgery, particularly in patients with congenital tracheal stenosis, prematurity and low body weight, associated complex heart and lung defects, ineffectiveness of previous operations.
Results. All patients survived. There was no mortality or complications during stenting procedure. Complications were noted in 4 (33.3%) cases and were as follows: pneumomediastinum without tension (n=1, 8.33%), development of tracheal granulations in the stent area (n=3, 25.0%). Among all 12 airway stenosis cases of different origin, stenting was effective in 10 (83.3%).
Conclusion. Airway stenting can be an alternative to or complement an open surgical procedure. The use of different type stents should correspond to a specific clinical situation and take into account the anatomical features of airway stenosis. The effectiveness of stenting is the survival in children with a high risk of mortality and the possibility of their further treatment.
Key words: tracheal stenosis, tracheomalacia, bronchomalacia, stenting.
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