支气管镜下球囊扩张成形术治疗儿童中心气道狭窄临床研究

Management of central airway stenosis by means of the flexible bronchoscopic balloon dilatation tracheoplasty in children

目的探讨支气管镜下球囊扩张成形术治疗儿童中心气道狭窄的有效性和安全性,并探寻治疗的最佳适应证和联合治疗的策略。方法 2009年7月至2012年4月对上海儿童医学中心34例经胸部CT平扫加气道三维重建技术和支气管镜检查明确存在中心气道狭窄患儿,给予支气管镜下球囊扩张成形术治疗,并对不同类型的中心气道狭窄球囊扩张术后的疗效、并发症以及转归进行综合分析。结果治疗有效16例,总体有效率47.1%。34例患儿按狭窄的成因性质分类,膜性狭窄9例,有效率100%;肌性狭窄5例,有效率60%;骨性狭窄20例,有效率20%。按狭窄的解剖形态分类,短段狭窄20例,有效率75%;长段狭窄12例,有效率8.3%;漏斗型狭窄2例,有效率为0。其中3例完全性气管环合并肺动脉吊带的患儿接受了外科肺动脉吊带纠治术以及气管滑动成形术,总体治疗有效率上升到55.9%。操作过程中出现一过性的低氧血症是最常见的并发症。结论球囊扩张成形术前,应充分了解中心气道狭窄的严重程度、长度、狭窄的成因性质,严格把握治疗的指征和时机。膜性短段狭窄的球囊扩张治疗效果较好,肌性狭窄多采取联合介入治疗的方法,骨性长段狭窄可采取手术治疗或姑息治疗的策略。

Objective To assess the efficiency and safety of the flexible bronchoscopic balloon dilatation traeheoplasty in children, and discuss the optimal indication and combined therapy of central airway stenosis in children. Methods From July 2009 to April 2012, 34 cases were diagnosed as central airway stenosis by chest CT scan and bronchoscpy in Shanghai Children＇s Medical Center, and received the treatment of the flexible bronchoscopic balloon dilatation tra- cheoplasty. Tbe data about the efficiency, complication and prognosis of the treatment were collected. Results In the 34 cases, 16 cases were improved after the treatment and the overall response rate was 47.1%. According to the patholo- gy of the stenosis, these cases were divided into three types： 9 cases were membranous stenosis, 5 cases were muscular stenosis and 20 cases were osseous stenosis. The response rate was 47.1%, 100%, and 20% respectively. According to the anatomy morphology of the stenosis, 20 cases were short distance stenosis and the response rate was 75%; 12 cases were long distance stenosis and the response rate was 8.3% ; 2 cases were funnel stenosis and the response rate was 0. Among these cases, 3 cases accepted the operation of pulmonary artery sling and tracheal sliding angioplasty, the total response rate being raised to 55.9%. The most common complication in the flexible bronehoseopic balloon dilatation tra- cheoplasty was transient oxygen desaturation. Conclusion The severity, length, pathology, indication and time of the treatment should be considered completely before the flexible bronchoscopic balloon dilatation tracheoplasty. The bal- loon dilatation therapy is suitable for membranous with short distance stenosis. The combined interventional treatment isgood for muscular stenosis, and the surgery and palliative treatment is an option for osseous with long distance ste- nosis.