Backer C L, Mavroudis C, Dunham M E, Holinger L
Northwestern University Medical School, and the Department of Surgery, The Children's Memorial Hospital, Chicago, Illinois 60614, USA.
J Pediatr Surg. 2000 Jun;35(6):813-8; discussion 818-9. doi: 10.1053/jpsu.2000.6847.
BACKGROUND/PURPOSE: Since 1996 a new procedure--the free tracheal autograft--has been used to repair long segment congenital tracheal stenosis (LSCTS). The purpose of this report is to examine the intermediate-term results of that technique.
Between January 1996 and July 1999, 10 infants underwent repair of LSCTS using a free tracheal autograft. Age ranged from 10 days to 23 months (mean age, 6.6 months). Six infants had a pulmonary artery (PA) sling; 5 had intracardiac anomalies. On cardiopulmonary bypass (CPB) the trachea was incised anteriorly through the area of stenosis. The midportion of the stenotic trachea was excised, and an end-to-end anastomosis was made posteriorly. The excised tracheal segment was trimmed and sutured in place anteriorly as a free autograft. In 5 patients the autograft was not long enough, and the upper portion of the tracheal opening was patched with pericardium.
There was 1 death 26 days postoperatively in a child that had simultaneous repair of tetralogy of Fallot and required extracorporeal membrane oxygenation postoperatively for cardiac failure. The other 9 children are alive and well at 2 to 44 months postoperatively (mean follow-up, 24 months). One child had autograft dehiscence and required replacement of the autograft with an aortic homograft. Two children have tracheostomies at 6 and 36 months postoperatively. All children have had serial postoperative bronchoscopic examinations. Most recent bronchoscopies have shown widely patent tracheal lumina in all survivors.
Intermediate-term follow-up of children with a free tracheal autograft continues to support our use of this technique as our procedure of choice for infants with LSCTS.
背景/目的：自1996年以来，一种新的手术方法——游离气管自体移植术，已被用于修复长段先天性气管狭窄（LSCTS）。本报告的目的是研究该技术的中期结果。
1996年1月至1999年7月期间，10例婴儿接受了游离气管自体移植术修复LSCTS。年龄范围为10天至23个月（平均年龄6.6个月）。6例婴儿有肺动脉吊带；5例有心内畸形。在体外循环（CPB）下，经狭窄区域前方切开气管。切除狭窄气管的中段，然后在后方进行端端吻合。切除的气管段修整后作为游离自体移植物缝合于前方原位。5例患者的自体移植物长度不够，气管开口上部用心包补片修补。
1例同时行法洛四联症修复术的患儿术后26天死亡，术后因心力衰竭需要体外膜肺氧合治疗。其他9例患儿术后2至44个月存活且情况良好（平均随访24个月）。1例患儿自体移植物裂开，需要用主动脉同种异体移植物替换自体移植物。2例患儿分别在术后6个月和36个月行气管造口术。所有患儿术后均接受了系列支气管镜检查。最近的支气管镜检查显示，所有存活患儿的气管腔均广泛通畅。
游离气管自体移植术患儿的中期随访结果继续支持我们将该技术作为LSCTS婴儿的首选手术方法。
