儿童气管狭窄的外科治疗

Surgical treatment of tracheal stenosis in children

目的探讨儿童气管狭窄的常见类型、手术方式及效果。方法回顾2017年12月至2020年8月南京医科大学附属儿童医院气管狭窄行外科治疗的23例患儿,其中男14例,女9例,手术时年龄2~23个月,平均(8.9±5.8)个月;体质量4.2~10.5 kg,平均(6.4±2.3)kg。气管狭窄包括完全性气管环9例,气管软化10例,声门下膜状环形增生4例。合并先天性心脏病类型包括肺动脉吊带10例,法洛四联症1例,室间隔缺损5例,肺动脉闭锁1例,右主动脉弓伴迷走左锁骨下动脉1例。手术方法包括Slide气管成形术9例,气管外支架悬吊术8例,气管内支架置入术2例,气管插管扩张术4例。术后1、3、6及12个月进行随访,行CT气管重建和纤维支气管镜检查。结果本组共1例死亡,死亡比例4.3%,为Slide气管成形术术后反复肉芽组织增生所致。再手术1例,为气管内支架取出后3个月,因心脏增大再次压迫左主支气管,再次行气管内支架置入术。随访1~24个月,所有患儿临床症状消失,复查CT及纤维支气管镜结果满意。结论完全性气管环采用Slide气管成形术,疗效满意;3D打印生物可吸收外支架有望成为治疗气管软化的首选方法。

Objective To investigate the common types,surgical treatment and effects of tracheal stenosis in children.Methods A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed,including 14 males and 9 females.The mean age at operation was(8.9±5.8)months(range:2-3 months)and the mean weight was(6.4±2.3)kg(range:4.2-10.5 kg).The common types of tracheal stenosis were complete tracheal ring in 9 children,tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4.The type of congenital heart diseases included 10 patients of pulmonary artery sling,1 of tetralogy of Fallot,5 of ventricular septal defect,1 of pulmonary atresia,and 1 of right aortic arch with aberrant left subclavian artery.Slide tracheoplasty was performed in 9 patients,external splint in 8,endotracheal stent in 2 and tracheal dilation in 4.All children were followed up after 1,3,6,and 12 months of operation with CT and bronchoscopy.Results There was 1 death in all 23 patients and the mortality was 4.3%,which died of granulation tissue hyperplasia after slide tracheoplasty.Reoperation was performed in 1 patient with endotracheal stent.All patients were followed for 1 to 24 months.Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion Slide tracheoplasty is the effective surgical method for complete trachea ring.3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.