先天性支气管狭窄手术治疗的预测因子:一项多中心文献分析

Background: Congenital tracheal stenosis (CTS) often requires urgent surgical intervention. We evaluated prognostic factors to determine the risks of surgical interventions by conducting a retrospective review of recent case series. Methods: Cases of CTS between 2002 and 2004 from our institution and recently published series that provided primary data on the demographics, complications, and outcomes of patients with CTS were analyzed. Univariate, model fit, and multivariate logistic regression analyses were performed using the SAS Statistical Program. Results: There were 68 patients who were treated (cartilage patch tracheoplasty, n = 31; slide tracheoplasty, n = 37), with 19 deaths (overall mortality = 28%). A total of 10 patients who underwent cartilage patch tracheoplasty died (32%mortality), whereas only 9 patients died following slide tracheoplasty (24%mortality). A total of 8 of 11 patients who were repaired at the age of 1 month or younger died (73%mortality), whereas only 11 of 57 patients who were repaired at an age older than 1 month died (19%mortality) (P = .04). A total of 10 of 19 patients with CTS who had comorbid intracardiac anomalies died following CTS repair (53%mortality), whereas only 9 of 49 patients with CTS who did not have intracardiac anomalies died (18%mortality) (P = .02). Conclusions: This is the first report on the prognostic factors determining surgical outcomes for CTS. The highest mortality rate was observed in CTS patients younger than 1 month and in those with intracardiac anomalies. Congenital tracheal stenosis repairs in these patient subgroups should be considered with caution.

先天性气管狭窄的治疗新挑战:一种个体化的治疗方法

Background: Congenital tracheal stenosis (CTS) may present as a life-threatening condition often requiring urgent surgical correction. We report our recent experience of 13 consecutive patients with CTS over the past 18 months. Method: Retrospective analysis of all patients with CTS admitted to our institution from January 2003 to June 2004. Results: Five of 13 patients (6 boys and 7 girls) were premature at birth. Mean age at repair was 3.8 months (range, 7 days to 9 months). Ten presented with cardiac arrests or “near-death”spells, 4 with copresenting pulmonary infection. Nine patients were local and 4 were national. Surgical repairs included slide tracheoplasty (n = 5), cartilage patch tracheoplasty (n = 4), patch-and-sli-de tracheoplasty (n = 1), and balloon dilatation(n = 1). Preoperative computed tomographic imaging invariably underestimated the severity of pathology. Two patients with minimal symptoms were treated nonoperatively. Two patients required additional endobronchial stents for bronchomalacia. Cardiopulmonary bypass was used in 8 patients. There were 3 deaths, including 2 planned withd rawal of treatment. Two patients remained in hospital. The remaining patients were discharged from our hospital. Conclusions: Presentation of CTS can be precipitated by respiratory infection. Preoperative imaging often underestimates the caliber and length of pathology. The treatment options for patients with CTS including observation should be individualized.

先天性膈疝治疗成功的代价:存活率提高的同时是否伴有长期并发症的增加

Background: The impact of “ gentle ventilation” (GV) strategies on morbidity and mortality of patients with congenital diaphragmatic hernia (CDH) in our institution has not been determined. This study reviews the primary and secondary outcomes of our patients with CDH treated with the GV approach. Method: We performed a retrospective chart review of respiratory, neurologic, nutritional, and musculoskeletal morbidities in patients with CDH treated at a single institution between 1985 and 1989 with conventional ventilation (CV) compared with those treated from 1996 to 2000 with GV. Results: There were 77 CV- treated and 66 GV- treated patients with CDH, with 51% survival in the CV cohort compared with 80% in the GV group (χ 2, P < 0.05). At 3- year follow- up, we found no statistically significant differences in the frequency of respiratory (38% of CV patients, 50% of GV patients), neurologic (29% of CV patients, 34% of GV patients), or musculoskeletal morbidity (46% of CV vs 29% of GV- treated patients). There was a difference in nutritional morbidity as indicated by the increased frequency of gastrostomy tube use in the GV- treated patients (34% ) compared with the CV patients (8% ; χ 2, P < 0.05). Conclusion: The implementation of GV techniques has significantly decreased mortality in infants with CDH. This has been associated with a documented increase in nutritional morbidity among survivors.

临床表现明显的血管环伴先天性气管狭窄患儿的长期预后

Aim: Congenital tracheal stenosis (CTS) associated with vascular rings (VRs) is considered a secondary condition,but relative indications for selective VRs or combined VR and CTS repairs are unclear. Here,we report long-term outcomes after VR repair associated with tracheal narrowing (TN). Method: Retrospective analysis of patients admitted to a single institution with VR from 1982 to 2004. Of 131 patients with VR (Cardiac Registry Database),29 (19 males,10 females; age range,0 days-4 years) associated with symptomatic TN. Patients were followed until age 18 years. Results: One hundred thirty-one patients with VR were categorized into 3 treatment groups. There were 102 patients with VR with no symptomatic TN treated by VR repair (4 deaths,4% mortality). Of the 29 patients with VR + TN symptoms,16 were treated by selective VR repair (mean age,5.3 months; range,17-288 days) with 3 deaths (19% mortality) and 13 underwent combined VR and CTS repairs (mean age,11 months; range,1 day-4 years) with 6 deaths (46% mortality),for an overall mortality of 31% (P < 0.01,χ 2 test). Of the 102 patients with VR,17 had intracardiac anomalies with 3 deaths (18% mortality). In contrast,7 of 29 patients with VR with TN and intracardiac anomalies died 4(57% mortality); 3 patients in combined cardiac and CTS repairs (2 deaths,67% mortality) and 4 in selective VR repairs (2 deaths,50% mortality). Conclusions: Not all cases of TN associated with VR require combined repairs. The presence of TN and/or intracardiac anomalies in patients with VR,however,increases mortality risk to the repair of VR. Surgical decision requires individualized clinical pathway.