McLaughlin R B, Wetmore R F, Tavill M A, Gaynor J W, Spray T L
Department of Otorhinolaryngology--Head and Neck Surgery, The Children's Hospital of Philadelphia and University of Pennsylvania School of Medicine, 19104, USA.
Laryngoscope. 1999 Feb;109(2 Pt 1):312-9. doi: 10.1097/00005537-199902000-00025.
OBJECTIVES/HYPOTHESIS: To review the clinical presentation and diagnostic evaluation of patients with symptomatic congenital vascular anomalies causing tracheobronchial compression and to establish the short- and long-term results of surgical intervention with respect to postoperative complications, persistent symptoms, and ventilator and tracheostomy dependence.
Retrospective review.
Chart review and telephone follow-up.
Between 1987 and 1996, 35 children underwent surgical intervention to relieve symptomatic tracheobronchial compression resulting from a congenital vascular anomaly. Historically, the onset of symptoms occurs within the first months of life; however, only 12 (34%) of patients were diagnosed by 6 months of age and 13 (37%) were diagnosed at greater than 1 year of age. Excluding anomalous innominate artery, chest radiography or barium swallow was suggestive of a congenital vascular anomaly in 30 (94%) of the patients. Magnetic resonance imaging correctly delineated the anatomy of the vascular anomaly in 29 patients. Bronchoscopy was diagnostic in all three patients with anomalous innominate arteries causing tracheal compression. Postoperative follow-up was obtained in 32 (91%) of patients; 25 (78%) of these were asymptomatic at the time of their most recent examination. The remaining patients had persistent stridor, recurrent respiratory tract infections, and/or chronic cough. In all three patients who underwent postoperative bronchoscopy for persistent symptoms, tracheomalacia was demonstrated in the region of previous compression.
Tracheobronchial compression from congenital vascular anomalies is a rare but treatable cause of respiratory symptoms. Early diagnosis requires a prompt, thorough clinical and radiologic evaluation. Surgery affords excellent long-term resolution of symptoms.
目的/假设：回顾有症状的先天性血管异常导致气管支气管受压患者的临床表现和诊断评估，并确定手术干预在术后并发症、持续症状以及呼吸机和气管造口依赖方面的短期和长期结果。
回顾性研究。
病历回顾和电话随访。
1987年至1996年期间，35名儿童接受了手术干预，以缓解先天性血管异常导致的有症状的气管支气管受压。从历史上看，症状在出生后的头几个月内出现；然而，只有12名（34%）患者在6个月大时被诊断出来，13名（37%）患者在1岁以上被诊断出来。排除无名动脉异常，胸部X线摄影或吞钡检查提示30名（94%）患者存在先天性血管异常。磁共振成像正确描绘了29名患者血管异常的解剖结构。支气管镜检查对所有3名因无名动脉异常导致气管受压的患者具有诊断价值。32名（91%）患者获得了术后随访；其中25名（78%）在最近一次检查时无症状。其余患者有持续性喘鸣、反复呼吸道感染和/或慢性咳嗽。在所有3名因持续症状接受术后支气管镜检查的患者中，先前受压区域均显示气管软化。
先天性血管异常导致的气管支气管受压是一种罕见但可治疗的呼吸道症状病因。早期诊断需要及时、全面的临床和影像学评估。手术能长期有效缓解症状。
