Lang F J, Hurni M, Monnier P
Department of Otorhinolaryngology and Head and Neck Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland.
J Pediatr Surg. 1999 Aug;34(8):1216-22. doi: 10.1016/s0022-3468(99)90155-0.
BACKGROUND/PURPOSE: The prognosis of long-segment funnel-shaped congenital tracheal stenosis improved with surgical management by enlargement-tracheoplasty with a pericardial patch. However, the final outcome is not always satisfying mainly because of the complications related to the pericardial graft and because of misdiagnosed associated cardiovascular malformations. The objective of the report is to show a further improvement of the prognosis by a thorough preoperative planning and the use of a slide-tracheoplasty for the cure of the stenosis, to avoid the major drawbacks of enlargement tracheoplasties.
Two children, 7 months and 3 years old, underwent a bronchoesophagoscopy, spiral computed tomography, an echocardiogram, and a heart catheterization. The tracheal stenosis and the associated severe cardiovascular malformations were cured during a single operative session under cardiopulmonary bypass; the tracheal stenosis was corrected by a slide-tracheoplasty.
The postoperative period was remarkably uneventful and the recovery extremely quick (hospital stay of 18 and 17 days). The midterm results are excellent, and the tracheal growth is not impaired (follow-up of 3 1/2 and 3 years).
According to the authors' experience and to the literature, the slide-tracheoplasty seems to be the most efficient surgical procedure for correction of long-segment funnel-shaped congenital tracheal stenosis. But the success of the treatment depends also on a complete preoperative diagnosis allowing a 1-stage surgical treatment of all associated thoracic malformations.
背景/目的：长节段漏斗状先天性气管狭窄的预后通过心包补片扩大气管成形术的手术治疗有所改善。然而，最终结果并不总是令人满意，主要是因为与心包移植物相关的并发症以及相关心血管畸形的误诊。本报告的目的是通过全面的术前规划和使用滑动气管成形术治疗狭窄来进一步改善预后，以避免扩大气管成形术的主要缺点。
两名儿童，分别为7个月和3岁，接受了支气管食管镜检查、螺旋计算机断层扫描、超声心动图和心导管检查。在体外循环下单次手术中治愈了气管狭窄和相关的严重心血管畸形；气管狭窄通过滑动气管成形术矫正。
术后恢复非常顺利，恢复极快（住院时间分别为18天和17天）。中期结果极佳，气管生长未受影响（随访3.5年和3年）。
根据作者的经验和文献，滑动气管成形术似乎是矫正长节段漏斗状先天性气管狭窄最有效的手术方法。但治疗的成功还取决于完整的术前诊断，以便对所有相关胸部畸形进行一期手术治疗。
