儿童先天性心脏病合并气管狭窄的综合治疗

Comprehensive treatment of congenital heart disease complicated with tracheal stenosis in children

目的总结儿童先天性心脏病合并气管狭窄的治疗经验。方法回顾性分析2016-01—2021-06郑州大学附属儿童医院胸心外科收治的35例先天性心脏病合并气管狭窄的患儿临床资料。其中,男21例,女14例;年龄2~38月。体质量4.1~11.3 kg。气管狭窄合并肺动脉吊带18例,血管环畸形11例,房间隔缺损4例,室间隔缺损2例。手术方式:气管成形术15例,其中气管端-端吻合7例、Slide成形术8例;气管周围松解术20例,其中6例术后无法脱离呼吸机、再次行气管内支架置入3例、外支架悬吊2例、Slide成形术1例。结果 35例患儿均顺利完成手术,Slide术后放弃治疗1例。34例患儿出院后1个月、3个月、6个月、1 a定期来院复查,失访3例。结论先天性心脏病合并不同程度的气管狭窄应个体化治疗。气管狭窄严重、呼吸困难症状明显患儿应积极行气管手术。长段气管狭窄首选Slide成形术,能明显改善患儿预后。

Objective To summarize the experience in the treatment of congenital heart disease complicated with tracheal stenosis in children.Methods Clinical data of 35 children with congenital heart disease complicated with tracheal stenosis admitted to the Department of Thoracic and Cardiac Surgery,Children's Hospital affiliated to Zhengzhou University from January 2016 to June 2021 were retrospectively analyzed.There were 21 males and 14 females.Ages from 2 to 38 months;Body weight 4.1~11.3 kg.There were 18 cases of tracheal stenosis with pulmonary artery sling,11 cases of vascular ring malformation,4 cases of atrial septal defect and 2 cases of ventricular septal defect.Operation method:Tracheoplasty was performed in 15 cases,including end-to-end tracheostomy in 7 cases and Slide plasty in 8 cases.There were 20 cases of peritracheal release,among which 6 cases could not be taken off the ventilator after operation,3 cases of endotracheal stent placement again,2 cases of external stent suspension,and 1 case of Slide plasty.Results All the 35 patients successfully completed surgery,and 1 patient gave up treatment after Slide(treated as death).Thirty-four children came to the hospital for regular review 1 month,3 months,6 months and 1 year after discharge,and 3 cases were lost to follow-up.Conclusion Congenital heart disease with different degrees of tracheal stenosis should be treated individually.Children with severe tracheal stenosis and obvious dyspnea should be actively treated with tracheal surgery.Slide angioplasty is preferred for long tracheal stenosis and can significantly improve the prognosis of these children.