medsovetМедицинский СоветMeditsinskiy sovet = Medical Council2079-701X2658-5790REMEDIUM GROUP Ltd.10.21518/ms2025-050medsovet-8979Research ArticleШКОЛА ПЕДИАТРАPEDIATRICIAN SCHOOLЭффективность эндоскопической хоанопластики без применения стентов у детей с врожденной атрезией хоанEfficacy of endoscopic choanoplasty without stents in children with congenital choanal atresiahttps://orcid.org/0000-0002-3116-6447АсмановА. И.AsmanovA. I.

Асманов Алан Исмаилович - к.м.н., руководитель отдела острой и хронической патологии уха, горла и носа, Научно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; ассистент кафедры оториноларингологии института хирургии, Национальный медицинский исследовательский центр оториноларингологии Федерального медико-биологического агентства.

125412, Москва, ул. Талдомская, д. 2; Москва, Волоколамское шоссе, д. 30, к. 2

Alan I. Asmanov - Cand. Sci. (Med.), Head of the Department of Acute and Chronic Pathology of the Ear, Throat and Nose, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov NMRU; Assistant of the Department of Otorhinolaryngology, Faculty of Pediatrics, The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of Russia.

2, Taldomskaya St., Moscow, 125412; 30, Bldg. 2, Volokolamskoe Shosse, Moscow, 123182

Alan-asmanov@yandex.ruhttps://orcid.org/0000-0002-5024-6135ГаращенкоТ. И.GarashchenkoT. I.

Гаращенко Татьяна Ильинична - д.м.н., профессор, ученый секретарь.

Москва, Волоколамское шоссе, д. 30, к. 2

Tatiana I. Garashchenko - Dr. Sci. (Med.), Professor, Scientific Secretary.

30, Bldg. 2, Volokolamskoe Shosse, Moscow, 123182

9040100@mail.ruhttps://orcid.org/0000-0002-2955-2015БеловВ. А.BelovV. A.

Белов Владимир Алексеевич - к.м.н., заведующий отделением оториноларингологии, Научно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; ассистент кафедры детской оториноларингологии им. профессора Б.В. Шеврыгина, РМАНПО.

125412, Москва, ул. Талдомская, д. 2; 125993, Москва, ул. Баррикадная, д. 2/1, стр. 1

Vladimir А. Belov - Cand. Sci. (Med.), Head of the Department of Otorhinolaryngology, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov NMRU; Assistant Professor of Pediatric Otorhinolaryngology named after Professor B.V. Shevrygin, Russian Medical Academy of Continuous Professional Education.

2, Taldomskaya St., Moscow, 125412; 2/1, Bldg. 1, Barrikadnaya St., Moscow, 125993

belov_v_a@mail.ruhttps://orcid.org/0000-0001-6897-0597ГороховА. С.GorokhovA. S.

Горохов Антон Сергеевич - к.м.н., заведующий отделением анестезиологии-реанимации, врач – анестезиолог-реаниматолог, Научноисследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; ассистент кафедры, РНИМУ имени Н.И. Пирогова.

125412, Москва, ул. Талдомская, д. 2; 119571, Москва, Ленинский пр-т, д. 117

Anton S. Gorokhov - Cand. Sci. (Med.), Head of the Department of Anesthesiology-Intensive Care Unit, Anesthesiologist-Intensive Care Unit, Veltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Assistant Professor at the Department of Innovative Pediatrics and Pediatric Surgery, Pirogov NMRU.

2, Taldomskaya St., Moscow, 125412; 117, Leninskiy Ave., Moscow, 119571

gorokhov@pedklin.ruНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; Национальный медицинский исследовательский центр оториноларингологии Федерального медико-биологического агентстваРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; The National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of RussiaRussian FederationНациональный медицинский исследовательский центр оториноларингологии Федерального медико-биологического агентстваРоссияThe National Medical Research Center for Otorhinolaryngology of the Federal Medico-Biological Agency of RussiaRussian FederationНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; Российская медицинская академия непрерывного профессионального образованияРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Russian Medical Academy of Continuous Professional EducationRussian FederationНаучно-исследовательский клинический институт педиатрии и детской хирургии имени академика Ю.Е. Вельтищева; Российский национальный исследовательский медицинский университет имени Н.И. ПироговаРоссияVeltischev Research and Clinical Institute for Pediatrics and Pediatric Surgery of the Pirogov Russian National Research Medical University; Pirogov National Medical Research UniversityRussian Federation20250504202501169175Copyright © Асманов А.И., Гаращенко Т.И., Белов В.А., Горохов А.С., 20252025Асманов А.И., Гаращенко Т.И., Белов В.А., Горохов А.С.Asmanov A.I., Garashchenko T.I., Belov V.A., Gorokhov A.S.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.med-sovet.pro/jour/article/view/8979Введение

Введение. За последние десятилетия предложены различные хирургические методы лечения врожденной атрезии хоан, однако до настоящего времени отсутствует единое мнение об оптимальной операции для лечения данной нозологии. Это обусловлено в том числе частым осложнением хирургического лечения детей с атрезией хоан – рестенозом неохоаны.

Цель

Цель. Разработать наиболее оптимальный метод хирургической коррекции врожденной атрезии хоан у детей для повышения эффективности лечения, улучшения прогноза и качества жизни.

Материалы и методы

Материалы и методы. 157 детей в возрасте от 1 дня до 17 лет с врожденной атрезией хоан были распределены на 2 группы: 1-я группа представлена ранее не оперированными детьми, которым была выполнена эндоскопическая хоанопластика без применения стентов, 2-я группа – дети с врожденной атрезией хоан с рецидивом (ранее проведена хоанопластика с применением стентов), которым также была выполнена бесстентовая хоанопластика.

Результаты и обсуждение

Результаты и обсуждение. Двусторонняя атрезия хоан диагностирована у 61 (38,9%) пациента, односторонняя – у 96 (61,1%). Среди пациентов с односторонней атрезией хоан правосторонняя атрезия зафиксирована у 54 (34,4%) детей, левосторонняя – у 42 (26,7%) исследуемых. После хирургического лечения при сравнении показателей качества жизни между 1-й и 2-й группами как в ближайшем, так и в отдаленном периодах не выявлены статистически значимые различия, при этом медиана показателя общего здоровья в 1-й группе составила 92 (90; 94), во 2-й группе 90 (88; 93) баллов уже спустя месяц после операции. Выводы. Доказана высокая эффективность новых хирургических технологий лечения врожденной атрезии хоан у детей, включая отсутствие рецидивов при использовании хоанотомии без применения стентов в обеих группах.

Introduction

Introduction. Over the last decades, various surgical methods have been proposed for the treatment of congenital choanal atresia, but to date there is no consensus on the optimal operation for the treatment of this nosology. This is due to the frequent complication of surgical treatment of children with choanal atresia – restenosis of the newly created choana.

Aim

Aim. To develop the most optimal method of surgical correction of congenital choanal atresia in children to improve the effectiveness of treatment, prognosis and quality of life.

Materials and methods

Materials and methods. 157 children aged from 1 day to 17 years with congenital choanal atresia were divided into two groups: Group 1 was represented by previously unoperated children who underwent endoscopic choanoplasty without stents, Group 2 – children with congenital choanal atresia with recurrence (previously underwent choanoplasty with stents) who also underwent stentless choanoplasty. The obtained results were compared between the groups.

Results

Results. Bilateral choanal atresia was diagnosed in 61 (38.9%) patients, unilateral – in 96 (61.1%). Among the patients with unilateral choanal atresia, right-sided atresia was recorded in 54 (34.4%) children, left-sided atresia – in 42 (26.7%) of the studied patients. After surgical treatment, comparing the quality of life, indicators between the 1st and 2nd groups, both in the immediate and distant periods, no statistically significant differences were revealed, with the median general health score in the 1st group being 92 (90; 94), in the 2nd group 90 (88; 93) points already one month after surgery.

Conclusions

Conclusions. High efficacy of new surgical technologies for the treatment of congenital choanal atresia in children, including the absence of recurrences when using choanotomy without stents in both groups, has been proved.

врожденная атрезия хоандиагностикалечениеэндоскопическая хоанопластикадетиcongenital choanal atresiadiagnosistreatmentendoscopic choanoplastychildrenReferencesMurray S, Luo L, Quimby A, Barrowman N, Vaccani JP, Caulley L. Immediate versus delayed surgery in congenital choanal atresia: A systematic review. Int J Pediatr Otorhinolaryngol. 2019;119:47–53. https://doi.org/10.1016/j.ijporl.2019.01.001.Murray S, Luo L, Quimby A, Barrowman N, Vaccani JP, Caulley L. Immediate versus delayed surgery in congenital choanal atresia: A systematic review. Int J Pediatr Otorhinolaryngol. 2019;119:47–53. https://doi.org/10.1016/j.ijporl.2019.01.001.Abdullah B, Singh S. Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies. Int J Environ Res Public Health. 2021;18(7):3441. https://doi.org/10.3390/ijerph18073441.Abdullah B, Singh S. Surgical Interventions for Inferior Turbinate Hypertrophy: A Comprehensive Review of Current Techniques and Technologies. Int J Environ Res Public Health. 2021;18(7):3441. https://doi.org/10.3390/ijerph18073441.D’Eredità R, Lens MB. Contact-diode laser repair of bony choanal atresia: a preliminary report. Int J Pediatr Otorhinolaryngol. 2008;72(5):625–628. https://doi.org/10.1016/j.ijporl.2008.01.011.D’Eredità R, Lens MB. Contact-diode laser repair of bony choanal atresia: a preliminary report. Int J Pediatr Otorhinolaryngol. 2008;72(5):625–628. https://doi.org/10.1016/j.ijporl.2008.01.011.Brietzke SE, Pusz MD. An anatomically based analysis of objectively measured pediatric snoring: a pilot study. Otolaryngol Head Neck Surg. 2015;152(3):561–566. https://doi.org/10.1177/0194599814564543.Brietzke SE, Pusz MD. An anatomically based analysis of objectively measured pediatric snoring: a pilot study. Otolaryngol Head Neck Surg. 2015;152(3):561–566. https://doi.org/10.1177/0194599814564543.Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie. 2024;103(S 01):S188–S213. https://doi.org/10.1055/a-2178-2957.Hackenberg S, Renson A, Röseler SM, Baumann I, Topcuoglu MY, Hebestreit H. Pädiatrische Rhinologie. Laryngorhinootologie. 2024;103(S 01):S188–S213. https://doi.org/10.1055/a-2178-2957.Gnagi SH, Schraff SA. Nasal obstruction in newborns. Pediatr Clin North Am. 2013;60(4):903–922. https://doi.org/10.1016/j.pcl.2013.04.007.Gnagi SH, Schraff SA. Nasal obstruction in newborns. Pediatr Clin North Am. 2013;60(4):903–922. https://doi.org/10.1016/j.pcl.2013.04.007.Kim TK, Jeong JY. Deviated nose: Physiological and pathological changes of the nasal cavity. Arch Plast Surg. 2020;47(6):505–515. https://doi.org/10.5999/aps.2020.01781.Kim TK, Jeong JY. Deviated nose: Physiological and pathological changes of the nasal cavity. Arch Plast Surg. 2020;47(6):505–515. https://doi.org/10.5999/aps.2020.01781.Kurosaka H. Choanal atresia and stenosis: Development and diseases of the nasal cavity. Wiley Interdiscip Rev Dev Biol. 2019;8(1):e336. https://doi.org/10.1002/wdev.336.Kurosaka H. Choanal atresia and stenosis: Development and diseases of the nasal cavity. Wiley Interdiscip Rev Dev Biol. 2019;8(1):e336. https://doi.org/10.1002/wdev.336.Zawawi F, McVey MJ, Campisi P. The Pathogenesis of Choanal Atresia. JAMA Otolaryngol Head Neck Surg. 2018;144(8):758–759. https://doi.org/10.1001/jamaoto.2018.1246.Zawawi F, McVey MJ, Campisi P. The Pathogenesis of Choanal Atresia. JAMA Otolaryngol Head Neck Surg. 2018;144(8):758–759. https://doi.org/10.1001/jamaoto.2018.1246.Ramsden JD, Campisi P, Forte V. Choanal atresia and choanal stenosis. Otolaryngol Clin North Am. 2009;42(2):339–352. https://doi.org/10.1016/j.otc.2009.01.001.Ramsden JD, Campisi P, Forte V. Choanal atresia and choanal stenosis. Otolaryngol Clin North Am. 2009;42(2):339–352. https://doi.org/10.1016/j.otc.2009.01.001.Ouattassi N, Wissam E, Asmae A, Zaki Z, El Alami MN. Current Management of Congenital Choanal Atresia: Litteratur Review. Indian J Otolaryngol Head Neck Surg. 2023;75(3):2227–2234. https://doi.org/10.1007/s12070-022-03398-2.Ouattassi N, Wissam E, Asmae A, Zaki Z, El Alami MN. Current Management of Congenital Choanal Atresia: Litteratur Review. Indian J Otolaryngol Head Neck Surg. 2023;75(3):2227–2234. https://doi.org/10.1007/s12070-022-03398-2.Patel VA, Carr MM. Congenital nasal obstruction in infants: A retrospective study and literature review. Int J Pediatr Otorhinolaryngol. 2017;99:78–84. https://doi.org/10.1016/j.ijporl.2017.05.023.Patel VA, Carr MM. Congenital nasal obstruction in infants: A retrospective study and literature review. Int J Pediatr Otorhinolaryngol. 2017;99:78–84. https://doi.org/10.1016/j.ijporl.2017.05.023.Habibullah A, Mogharbel AM, Alghamdi A, Alhazmi A, Alkhatib T, Zawawi F. Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study. Cureus. 2022;14(9):e28928. https://doi.org/10.7759/cureus.28928.Habibullah A, Mogharbel AM, Alghamdi A, Alhazmi A, Alkhatib T, Zawawi F. Characteristics of Choanal Atresia in Patients With Congenital Anomalies: A Retrospective Study. Cureus. 2022;14(9):e28928. https://doi.org/10.7759/cureus.28928.Randall DA. Current Indications for Tonsillectomy and Adenoidectomy. J Am Board Fam Med. 2020;33(6):1025–1030. https://doi.org/10.3122/jabfm.2020.06.200038.Randall DA. Current Indications for Tonsillectomy and Adenoidectomy. J Am Board Fam Med. 2020;33(6):1025–1030. https://doi.org/10.3122/jabfm.2020.06.200038.Taghiloo H, Halimi Z. The frequencies of different types of nasal septum deviation and their effect on increasing the thickness of maxillary sinus mucosa. J Dent Res Dent Clin Dent Prospects. 2019;13(3):208–214. https://doi.org/10.15171/joddd.2019.032.Taghiloo H, Halimi Z. The frequencies of different types of nasal septum deviation and their effect on increasing the thickness of maxillary sinus mucosa. J Dent Res Dent Clin Dent Prospects. 2019;13(3):208–214. https://doi.org/10.15171/joddd.2019.032.Walsh J, Rastatter J. Neonatal Tracheostomy. Clin Perinatol. 2018;45(4):805–816. https://doi.org/10.1016/j.clp.2018.07.014.Walsh J, Rastatter J. Neonatal Tracheostomy. Clin Perinatol. 2018;45(4):805–816. https://doi.org/10.1016/j.clp.2018.07.014.Alvo A, Villarroel G, Sedano C. Neonatal nasal obstruction. Eur Arch Otorhinolaryngol. 2021;278(10):3605–3611. https://doi.org/10.1007/s00405-020-06546-y.Alvo A, Villarroel G, Sedano C. Neonatal nasal obstruction. Eur Arch Otorhinolaryngol. 2021;278(10):3605–3611. https://doi.org/10.1007/ s00405-020-06546-y.Bangiyev NB, Govil N, Sheyn A, Haupert M, Thottam PJ. Novel application of steroid eluting stents in choanal atresia repair: a case series. Ann Otol Rhinol Laryngol. 2017;126(1):79–82. https://doi.org/10.1177/0003489416671533.Bangiyev NB, Govil N, Sheyn A, Haupert M, ThottamPJ. Novel application of steroid eluting stents in choanal atresia repair: a case series. Ann Otol Rhinol Laryngol. 2017;126(1):79–82. https://doi.org/10.1177/0003489416671533.Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J et al. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):51–56. https://doi.org/10.1016/j.otorri.2020.01.002.Bartel R, Levorato M, Adroher M, Cardelus S, Diaz A, Lacima J et al. Performance of endoscopic repair with endonasal flaps for congenital choanal atresia. A systematic review. Acta Otorrinolaringol Esp (Engl Ed). 2021;72(1):51–56. https://doi.org/10.1016/j.otorri.2020.01.002.Saafan ME. Endoscopic management of congenital bilateral posterior choanal atresia: value of using stents. Eur Arch Otorhinolaryngol. 2013;270(1):129–134. https://doi.org/10.1007/s00405-012-1956-0.Saafan ME. Endoscopic management of congenital bilateral posterior choanal atresia: value of using stents. Eur Arch Otorhinolaryngol. 2013;270(1):129–134. https://doi.org/10.1007/s00405-012-1956-0.Meleca JB, Anne S, Hopkins B. Reducing the need for general anesthesia in the repair of choanal atresia with steroid-eluting stents: a case series. Int J Pediatr Otorhinolaryngol. 2019;118:185–187. https://doi.org/10.1016/j.ijporl.2019.01.004.Meleca JB, Anne S, Hopkins B. Reducing the need for general anesthesia in the repair of choanal atresia with steroid-eluting stents: a case series. Int J Pediatr Otorhinolaryngol. 2019;118:185–187. https://doi.org/10.1016/j.ijporl.2019.01.004.Urbančič J, Vozel D, Battelino S, Boršoš I, Bregant L, Glavan M et al. Management of Choanal Atresia: National Recommendations with a Comprehensive Literature Review. Children. 2023;10(1):91. https://doi.org/10.3390/children10010091.Urbančič J, Vozel D, Battelino S, Boršoš I, Bregant L, Glavan M et al. Management of Choanal Atresia: National Recommendations with a Comprehensive Literature Review. Children. 2023;10(1):91. https://doi.org/10.3390/children10010091.Егоров ВИ, Юнусов АС, Сайдулаева АИ. Использование транссептального доступа при хирургическом лечении врожденных атрезий хоан в детском возрасте. Российская оториноларингология. 2017;6(91):51–55. https://doi.org/10.18692/1810-4800-2017-6-51-55.Egorov VI, Yunusov AS, Saidullayeva AI. The use of transeptal access in the surgical treatment of congenital atresia of hoan in childhood. Rossiiskaya Otorinolaringologiya. 2017;6(91):51–55. https://doi.org/10.18692/1810-4800-2017-6-51-55.Eravcı FC, Uçar G, Özcan KM, Çolak M, Ergün Y, Açıkgöz Y et al. The effect of chemotherapy on olfactory function and mucociliary clearance. Support Care Cancer. 2021;29(3):1635–1641. https://doi.org/10.1007/s00520020-05639-y.Eravcı FC, Uçar G, Özcan KM, Çolak M, Ergün Y, Açıkgöz Y et al. The effect of chemotherapy on olfactory function and mucociliary clearance. Support Care Cancer. 2021;29(3):1635–1641. https://doi.org/10.1007/s00520020-05639-y.Bajin MD, Önay Ö, Günaydın RÖ, Ünal ÖF, Yücel ÖT, Akyol U, Aydın C. Endonasal choanal atresia repair; evaluating the surgical results of 58 cases. Turk J Pediatr. 2021;63(1):136–140. https://doi.org/10.24953/turkjped.2021.01.016.Bajin MD, Önay Ö, Günaydın RÖ, Ünal ÖF, Yücel ÖT, Akyol U, Aydın C. Endonasal choanal atresia repair; evaluating the surgical results of 58 cases. Turk J Pediatr. 2021;63(1):136–140. https://doi.org/10.24953/turkjped.2021.01.016.Raposo-Amaral CE, Ghizoni E, Raposo-Amaral CA. Apert Syndrome: Selection Rationale for Midface Advancement Technique. Adv Tech Stand Neurosurg. 2023;46:245–266. https://doi.org/10.1007/978-3-031-28202-7_13.Raposo-Amaral CE, Ghizoni E, Raposo-Amaral CA. Apert Syndrome: Selection Rationale for Midface Advancement Technique. Adv Tech Stand Neurosurg. 2023;46:245–266. https://doi.org/10.1007/978-3-031-28202-7_13.Gilony D, Scheuerman O, Kornreich L, Hod R, Raveh E. Unilateral Choanal Atresia Presenting With Congenital Respiratory Distress and Recurrent Cyanotic Episodes. Ear Nose Throat J. 2023;102(9):NP429–NP431. https://doi.org/10.1177/01455613211020978.Gilony D, Scheuerman O, Kornreich L, Hod R, Raveh E. Unilateral Choanal Atresia Presenting With Congenital Respiratory Distress and Recurrent Cyanotic Episodes. Ear Nose Throat J. 2023;102(9):NP429–NP431. https://doi.org/10.1177/01455613211020978.Gosepath J, Santamaria VE, Lippert BM, Mann WJ. Forty-one cases of congenital choanal atresia over 26 years-retrospective analysis of outcome and technique. Rhinology. 2007;45(2):158–163. Available at: https://pubmed.ncbi.nlm.nih.gov/17708465/.Gosepath J, Santamaria VE, Lippert BM, Mann WJ. Forty-one cases of congenital choanal atresia over 26 years-retrospective analysis of outcome and technique. Rhinology. 2007;45(2):158–163. Available at: https://pubmed.ncbi.nlm.nih.gov/17708465/.Bajin MD, Önay Ö, Günaydın RÖ, Ünal ÖF, Yücel ÖT, Akyol U, Aydın C. Endonasal choanal atresia repair; evaluating the surgical results of 58 cases. Turk J Pediatr. 2021;63(1):136–140. https://doi.org/10.24953/turkjped.2021.01.016.Bajin MD, Önay Ö, Günaydın RÖ, Ünal ÖF, Yücel ÖT, Akyol U, Aydın C. Endonasal choanal atresia repair; evaluating the surgical results of 58 cases. Turk J Pediatr. 2021;63(1):136–140. https://doi.org/10.24953/turkjped.2021.01.016.

The authors declare that there are no conflicts of interest present.