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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Candidate's Thesis: Laryngotracheal separation in neurologically impaired children: long-term results.
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Candidate's Thesis: Laryngotracheal separation in neurologically impaired children: long-term results.

机译：候选论文：神经系统受损儿童的喉气管分离：长期结果。

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OBJECTIVES: Fifty-six consecutive neurologically impaired pediatric children underwent laryngotracheal separation (LTS) for acute recurrent and chronic aspiration in the last 18 years. The population demographics, indications for surgery, and comorbidities are reviewed. This study reports early and late complications and survivorship including admissions for pneumonia/aspiration. Diagnosis related group (DRGs) and work relative value units (wRVUs) were measured to document the potential benefits before and after LTS. STUDY DESIGN: Retrospective review of patient charts and records in an electronic medical record during an 18 year period. METHODS: Information was obtained by a chart review and utilization of the electronic medical record. Patient specific DRG and wRVU data on their hospitalizations and outpatient encounters at the Alfred I. duPont Hospital for Children of the Nemours Foundation and survival data were recorded. Data was analyzed using chi-square analysis, a two-tailed t test, and a Fisher's Exact test. RESULTS: Laryngotracheal separation achieved complete control of aspiration in all the children. A significant reduction in the number of hospital admissions for pneumonias after surgery was noted. After LTS there was a reduced average number of DRGs per month (p < .001) as well as wRVUs. Transient fistula formation (11%) was the most common complication. No patient had his or her procedure reversed to date. CONCLUSION: Laryngotracheal separation is 100% effective in controlling aspiration in all of neurologically impaired children in this study, It is a valuable procedure to prolong the life of children who have intractable aspiration. After LTS, a decrease in DRGs and wRVUs reduces health care costs for these patients. Prior to LTS, all medical and surgical treatment options for aspiration should be discussed and considered, based on the extent of the child's underlying neurologic status, ability to verbally communicate, degree of upper airway obstruction, and hope of recovery of neurologic function.
机译：目的：在过去的18年中，对56例连续的神经系统受损的儿科儿童进行了喉气管分离术（LTS），以进行急性复发性和慢性误吸。人口统计，手术适应症和合并症进行了审查。这项研究报告了早期和晚期并发症和存活率，包括肺炎/吸入性肺炎的入院率。测量诊断相关组（DRG）和工作相对价值单位（wRVU），以记录LTS前后的潜在收益。研究设计：回顾性审查18年来的患者病历和电子病历中的记录。方法：通过图表审查和利用电子病历获得信息。记录了内穆尔基金会儿童阿尔弗雷德·杜邦儿童医院住院和门诊患者的特定于患者的DRG和wRVU数据，并记录了生存数据。使用卡方分析，两尾t检验和Fisher精确检验对数据进行分析。结果：喉气管分离术对所有儿童均实现了完全的抽吸控制。注意到手术后因肺炎住院的人数大大减少。 LTS后，每月的DRG和wRVU均减少（p <.001）。短暂性瘘管形成（11％）是最常见的并发症。迄今没有患者逆转手术。结论：本研究中喉气管分离术可有效控制所有神经系统受损儿童的吸入，这对于延长顽固性吸入性儿童的寿命是一项有价值的程序。 LTS后，DRG和wRVU的减少可降低这些患者的医疗保健成本。在进行LTS之前，应根据孩子潜在的神经系统状况，口头交流能力，上呼吸道阻塞程度以及神经系统功能恢复的希望，讨论和考虑所有用于抽吸的医学和外科治疗方案。

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