保守疗法治疗先天性气管狭窄的效果:一项循证长期随访研究

Background/Purpose:Surgery has been the management of choice for severe congenital tracheal stenosis (CTS). The role of conservative management of CTS however is not clear. The aim of this study is to characterize the natural history of CTS,review the radiologic evidence of tracheal growth,and evaluate the clinical outcome and selection criteria of conservative management of CTS. Methods:A retrospective study was carried out on 22 consecutive children with symptomatic CTS admitted into a single institution between 1982 and 2001. The patients were categorized into operation (n = 11) and observation(n = 11) groups. Six patients of the observation group were followed up with serial computed tomography scan. Their tracheal growth was compared with that of healthy children of the same age. Results:The mortality rates of observation and operation groups were 9%and 27%,respectively,although the latter group consisted of more severely affected patients. The pathologic categorization of the CTS influenced the survival rates (P = 0.046,χ2),with the long segment type having the worst prognosis (67%). Serial computed tomography scans of 6 conservatively managed patients revealed that all stenotic tracheas continued to grow (P = .039,2-tailed paired Student’s t test). Of the 6 stenotic tracheas,5 grew at a faster-than normalrate,and the stenotic tracheal diameters approached those of normal diameters by the age of 9 years. Conclusions:The management of patients with symptomatic CTS should be individualized. A selected group of patients with CTS can be safely managed nonoperatively.

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.

10年来在气管软化和(或)支气管软化的处理中应用气管/支气管腔内支架术是否优于主动脉固定术

We compared the efficacy and clinical outcomes of aortopexy versus tracheal stents in the management of tracheomalacia. Methods: A retrospective analysis of 25 consecutive patients undergoing aortopexy (n = 11; 8 boys, 3 girls) or tracheal stents (n = 14; 9 boys, 5 girls) between 1993 and 2003 was performed. Results: Both treatment groups, aortopexy versus stents, were comparable in their mean age of diagnosis, timing of intervention, surgical indications (“ dying spell” or failed extubation), and previous underlying conditions. The operative time (190 vs 72 minutes) and blood loss (26 vs 0 mL) were significantly greater in aortopexy group (P < . 01). There were no perioperative deaths in either group. Interestingly, 4 of 11 patients in the aortopexy group developed pericardial effusion (P <. 01). With stents in place for a mean of 15 (range 2- 41) months, 3 of 8 patients with stent removal had significant granulation tissue requiring further dilatation. No death was observed in aortopexy group, whereas 1 stentrelated death and 1 cardiac arrest requiring median sternotomy occurred during stent removal in 44 and 32 months’ follow-up, respectively. Conclusion: Both aortopexy and tracheal stents are effective treatment modalities in the management of tracheomalacia. However, although aortopexy is associated with early perioperative complications, tracheal stents are associated with higher failure rate and more severe stent-related morbidity and mortality.

用支气管镜成功从气道中去除梯牧草

Aspiration of Timothy grass in the airway is a well-recognized cause of bronc hiectasis, and management often requires pulmonary resection. The authors descri be 2 cases of Timothy grass aspiration with established pulmonary infection that were successfully managed by bronchoscopic removal with subsequent improvement. Every effort should be made to accomplish this goal, and pulmonary resection sh ould be considered a last resort in these cases.

误吞金属丝引起食管穿透性损伤

Esophageal foreign bodies are frequently encountered in the pediatric population, and a high degree of suspicion should be maintained in the setting of postprandial dysphagia. We report the case of a 14- year-old boy with a penetrating esophageal injury after the accidental ingestion of a wire bristle from a grill brush.