儿童先天性完全性气管环的临床及诊治特点

Clinical features and management of congenital complete tracheal rings in children

目的探讨儿童先天性完全性气管环(CCTR)的临床及诊治特点。方法 2008年1月—2009年12月628例支气管镜检查患儿中诊断CCTR 18例,随访7～27个月,对其临床特点、影像学表现、镜下特征、治疗及转归进行综合分析。结果 18例中15例表现为反复咳喘,1例为气管插管困难,2例为术后撤机困难。CCTR多位于气管的中下部,合并支气管桥畸形时CCTR位于左主支气管。所有病例均经支气管镜检查确诊。治疗及转归:4例行气管成形术,3例死亡,1例预后好;3例行球囊扩张术,2例术后喘息改善;11例未对CCTR进行处理,6例预后好,2例仍反复喘息,3例死亡。结论 CCTR多表现为反复咳喘。支气管镜是诊断CCTR的金标准,对球囊扩张术有部分治疗作用,需根据临床情况选择适当的治疗方式及手术时机。

Objective To explore the clinical features,diagnostic criteria and treatment of congenital complete tracheal rings（CCTR）in children.Methods Among 628 patients examined by bronchoscopy from Jan 2008 to Dec 2009,18 cases were confirmed to have CCTR.They were observed for two to twenty-seven months and their clinical characteristics,examinations,airway lesion,treatment and prognosis were collected and analyzed.Results Fifteen cases had recurrent or prolonged wheezing and dyspnea,1 case failed intubation,2 cases depended on mechanical ventilation after operation.Most tracheal stenosis segments involved in the middle and/or lower part of the tracheal and the left main bronchus were involved when bronchial bridge existed.All patients were diagnosed by bronchoscopy.Four cases underwent repair of tracheoplasty,1 was good and 3 died.Balloon dilation was used in 3 patients,the condition of 2 were improved.Among 11 patients who haven＇t been treated for CCTR,6 had good outcome,2 had persistent or worsening symptoms and 3 died.Conclusions Most cases of CCTR had wheezing and dyspnea.Bronchoscopy should be regarded as a＂golden standard＂method for diagnosing CCTR.Balloon dilation had partial therapeutic effect on CCTR.Appropriate treatment and operation time should be considered according to patients＇ clinical features.