非体外循环手术治疗肺动脉吊带合并气管狭窄的临床研究

Surgical treatment to 22 cases of pulmonary artery sling and tracheal stenosis with non-cardiopulmonary bypass

目的回顾分析总结非体外循环手术治疗肺动脉吊带合并气管狭窄的诊治经验。方法2012年11月至2015年9月，在非体外循环下手术治疗肺动脉吊带合并气管狭窄患儿22例，其中男性13例、女性9例，年龄4个月至11岁，平均（20．33±27．64）个月，体质量5．5±32．0（10．25±5．80）kg。患儿均因“呼吸急促伴喉喘鸣”在外院就诊，心脏超声和心血管CT诊断为肺动脉吊带合并气管狭窄转入我院。单纯肺动脉吊带8例，合并其他心血管畸形11例，合并非心血管畸形3例。22例患儿均有不同程度的气管狭窄。结果22例患儿均在非体外循环下行肺动脉吊带矫治手术，成功21例，失败1例。7例同期矫治了合并的其他心血管畸形（房间隔缺损封堵术1例、动脉导管离断术6例）；1例同期纠治膈膨升。术后呼吸机辅助时间2～28（5．35±5．57）h，监护室逗留时间16．5±288．0（61．25±65．00）h。术后发生乳糜胸1例，保守治疗后痊愈；1例患儿术后并发气管内肉芽生成造成气道狭窄加重，脱离呼吸机困难，术后10d行气管内支架置入手术，术后顺利脱离呼吸机，痊愈出院；1例患儿在手术失败后12d再次体外循环下手术，术后42d仍不能脱离呼吸机。最终家长放弃治疗。全组患儿无手术死亡，21例顺利出院。术后患儿随访时间1-33个月，12例患儿术后呼吸道症状完全消失，9例患儿喉喘鸣症状明显好转，生长发育改善，气管狭窄随访中。结论肺动脉吊带患儿一经诊断即有手术指征。采用经左侧开胸非体外循环下手术矫治方法简单，术后呼吸机撤离快，住院时间短，近期效果良好。

Objective To review and analyze the diagnosis and treatment to the children with pulmonary artery sling （PAS） and tracheal stenosis. Methods From November 2012 to September 2015, 22 PAS ehlidren with tracheal stenosis were treated, including 13 males and 9 females, aged from 4 months to 11 years old, mean was （20.33±27.64）months; the body mass was 5.5-32.0 （10.25±5.80）kg. The patients were hospitalized of the shortness of breath and laryngeal stridor, cardioechology and cardiovascular CT scan made the clear diagnosis. 11 cases combined with other cardiovascular defect and 3 cases combined with non-cardiovascular malformations. Results 22 patients underwent operation treatment, 21 cases were successful, 1 case failed, 7 eases with other cardiovascular malformations were treated samutaniously（ 1 case with atrial septal defect was closed trans-catheterly, 6 cases with patent ductus arteriosus were ligated）, 1 ease with diaphragmatic eventration was repaired. Post- operative mechanical ventilation time was 2-28 （ 5.35 ±5.57 ）hours, ICU stay time was 16.5-288.0 （61.25 ±65.00） hours, 1 case with chylothorax was cured with conservative therapy, 1 case with severe tracheal stenosis which was caused by endotraeheal granuloma, this patient was difficult to wean from the ventilator, stent implantation done to the patient 10 days after operation then discharged smoothly, 1 failed case was repaired with cardiopulmonary bypass 12 days after first operation, it was also difficulty to wean from wentilator, finally the patient was given up 42 days postoperatively, there were no operation death, 21 cases discharged. The respiratory symptoms were completely disappeared in 12 cases, 9 cases were improved, the growth and development was normal, and the follow-up of tracheal stenosis was continued. Conclusion The patients of PAS should be surgical treated once clear diagnosed. The left thoracotomy approach were used to treat patients with no cardiopulmonary bypass, the patients could wean from mechanical ventilation quickly and the time of hospital stay was short.