肺动脉吊带合并异常支气管分支和气管狭窄手术治疗的临床评价

Clinical assessment of the treatment for pulmonary artery sling combined with anomalous bronchial branching and congenital tracheal stenosis

目的:总结异常支气管分支合并肺动脉吊带形态学特征,评价手术治疗效果,为肺动脉吊带的治疗提供新思维。方法:回顾2012年1月至2018年12月上海儿童医学中心存在异常支气管分支的患儿资料。根据异常支气管分支形态分为气管性支气管、三叉型支气管、气管桥和气管性支气管合并三叉型支气管4种类型。统计4种异常支气管分支形态合并肺动脉吊带比例及行气管成形术比例。测量气管成形术前、后隆凸/假隆凸下角度。结果:本次研究共纳入140例存在异常支气管分支的病例。11例(21%,11/53)气管性支气管和4例(9%,4/44)三叉型支气管气管直径正常。125例(89%,125/140)合并气管狭窄,其中115例行气管成形术,且均合并完全性气管环。气管桥患儿均行气管成形术,手术比例高于气管性支气管(100%对60%,P=0.000)。76例(61%,76/125)合并肺动脉吊带,均一期处理异常血管和狭窄气管。术后隆凸/假隆凸下角度明显减小(P=0.000)。结论:肺动脉吊带合并异常支气管分支和气管狭窄难以用单纯血管压迫解释,应积极考虑同期行气管成形术。滑片吻合术是目前治疗先天性气管狭窄的主流技术。

Objective To summarize the morphological characteristics and clinical experience of pulmonary artery sling(PAS)combined with anomalous bronchial branching,and provide new considerations for surgically treating PAS.Methods A retrospective review of surgical experience of all patients with anomalous bronchial branching from January 2012 to December 2018 at Shanghai Children's Medical Center was conducted.There are 4 types according to the morphology of anomalous bronchial branching:tracheal bronchus,bronchial trifurcation,bridging bronchus,tracheal bronchus combined with bronchial trifurcation.The proportion of patients with anomalous bronchial branching combined with PAS was counted.The rate of tracheoplasty for four types was determined.We measured the interbronchial and subcarinal/subpseudocarinal angles before and after tracheoplasty.Results 140 patients were included in our study.The tracheal diameter of 11(21%,11/53)patients with tracheal bronchus and 4(9%,4/44)patients with bronchial trifurcation was normal.Among these patients,125 patients had congenital tracheal stenosis(CTS).115 patients underwent tracheoplasty.The rate of tracheoplasty of bridging bronchus was higher than tracheal bronchus(100%vs.60%,P=0.000).One-stage surgery was performed in 76(61%)patients who had PAS.The interbronchial and subcarinal/subpseudocarinal angles were significantly reduced postoperatively(P=0.000).Conclusion It is difficult to explain merely with vascular compression in patients with PAS with CTS and anomalous bronchial branching.One-stage slide tracheoplasty is currently the optimal option.