气管支架治疗儿童先天性心脏病合并气管梗阻的临床效果

Clinical study of tracheal stent in the treatment of congenital heart disease with airway obstruction in children

目的研究气管支架置入治疗先天性心脏病(先心病)术前气管狭窄无法插管及术后脱机困难的先天性气管梗阻的临床效果。方法2015年3月至2017年12月23例先心病合并重度气管狭窄的患儿施行了先心病矫治术及气管支架置入术,术前诊断均行支气管镜及CT气管重建为评价依据,出院后随访1~24个月,且每1~3个月返院行支气管镜检查。结果随访20例。21例在支架置入术后1周拔除气管插管,改为经鼻持续气管正压通气,术后2周转入普通病房,术后4周出院;1例因肺部感染较重,入院4个月后好转出院;1例因反复生成的肉芽组织及坏死上皮脱落堵塞气管,放弃治疗。22例近期随访支气管镜下可见支架上皮化良好,13例取出(部分取出)支架顺利,患儿生长发育良好。结论先心病术前因气管狭窄无法进行气管插管,术后合并难以控制的肺部感染、肺不张脱机失败的患儿多存在严重的气管梗阻,经支气管镜置入及取出气管支架,是有效的治疗方法,但仍存在较多并发症,需要严格掌握指征。

Objective To study the clinical effect of endotracheal stent implantation for treatment of congenital tracheal obstruction due to preoperative airway stenosis and postoperative dislocation difficulty. Methods23 children with congenital heart disease complicated with severe tracheal stenosis were treated in our hospital from March 2015 to December 2017. The operation of congenital heart disease and airway stenting were performed. The preoperative diagnosis of the children was based on the bronchoscopy and CT airway reconstruction, and the patients were followed up for 1 to 24 months after the hospital was discharged. And every 1 to 3 month, the hospital was assessed by FFB. Results 20 children had good growth and development, and 21 of the 23 cases were removed by tracheal intubation to NCPAP within 1 weeks after the stent implantation, and they were transferred to the general ward within 2 weeks after the operation, and the hospital was discharged within 4 weeks after the operation. 1 children were discharged from hospital in 4 month after the operation , because of severe lung infection. In 1 cases, the airway was blocked by recurrent granulation tissue and necrotic epithelium, the treatment was abandoned. 22 cases of children were followed up by FFB. The stent was well epithelialization. 13 out of 23 cases were successfully removed. Conclusion Tracheal intubation can not be performed in children with congenital heart disease due to airway stenosis before operation. After operation, with uncontrolled pulmonary infection and atelectasis, the children often failed to removing intubation. By FFB, the airway stent of implantation and removal are one of the effective treatment methods. However, there are still many complications and need to be strictly controlled.