Matúte J A, Romero R, Garcia-Casillas M A, de Agustìn J C, Marhuenda C, Berchi F J, Vazquez J
Department of Pediatric Surgery, Hospital Infantil Gregorio Marañón, Madrid, Spain.
J Pediatr Surg. 2001 Feb;36(2):320-3. doi: 10.1053/jpsu.2001.20706.
The aim of this study was to evaluate the results obtained by 2 different techniques of tracheoplasty in the treatment of long-segment, funnel-shaped congenital tracheal stenosis (CTS) in 2 tertiary paediatric hospitals.
The clinical records of patients with long segment congenital tracheal stenosis during the period January 1990 to June 1999 were reviewed retrospectively. Age, gender, symptoms, imaging (x-ray, computed tomography, magnetic resonance imaging, or bronchography), endoscopic findings, associated anomalies, treatment, intubation time, postoperative treatment, intensive care unit stay, complications, hospital stay, evolution, and follow-up time were analyzed. Short congenital tracheal stenosis treated by resection and end-to-end anastomosis are not included. Results are given as mean +/- SEM.
Ten (7 boys, 4 girls) of 14 patients with CTS had a funnel-shaped CTS. Mean age at treatment was 9.7 +/- 4.8 months (range, 3 days to 4.7 years). All of the patients presented with CTS affecting the distal third of the trachea and 4 of them extension to 1 main stem bronchus. They were treated by 2 different types of tracheoplasty: anterior costal cartilage graft (ACGT, 6 patients) and slide tracheoplasty (ST, 4 patients). All the patients treated by ACGT failed: 4 died and 2 required further surgery for restenosis. Causes of death were acute respiratory failure during surgery (2 cases) and anastomotic dehiscence (2 cases). The patients treated with ST are asymptomatic and doing well. Mean postoperative intubation time of the ACGT group was 35 +/- 25 days (10 to 60 days), whereas in the ST group it was 14 +/- 12 days (0 to 51 days). Mean hospital stays were 292 +/- 271 days (21 to 563 days) and 24 +/- 13 days (7 to 63 days), respectively. Mean follow-up time is 28 +/- 14 months (3 to 94 months).
Surgery of long-segment congenital tracheal stenosis has a high failure and complication rate with vital implications in prognosis. Treatment should be done in a multidisciplinary basis by a highly trained and motivated team. Slide tracheoplasty seems to be the better option, although further multicentre studies should be conducted.
本研究旨在评估两家三级儿科医院采用两种不同气管成形术治疗长节段漏斗状先天性气管狭窄（CTS）的效果。
回顾性分析1990年1月至1999年6月期间长节段先天性气管狭窄患者的临床记录。分析年龄、性别、症状、影像学检查（X线、计算机断层扫描、磁共振成像或支气管造影）、内镜检查结果、相关畸形、治疗方法、插管时间、术后治疗、重症监护病房停留时间、并发症、住院时间、病情进展及随访时间。不包括采用切除及端端吻合术治疗的短节段先天性气管狭窄。结果以均值±标准误表示。
14例CTS患者中有10例（7例男孩，4例女孩）为漏斗状CTS。治疗时的平均年龄为9.7±4.8个月（范围3天至4.7岁）。所有患者的CTS均累及气管远端三分之一，其中4例延伸至1个主支气管。他们接受了两种不同类型的气管成形术治疗：前肋软骨移植术（ACGT，6例）和滑动气管成形术（ST，4例）。所有接受ACGT治疗的患者均失败：4例死亡，2例因再狭窄需要进一步手术。死亡原因是手术期间急性呼吸衰竭（2例）和吻合口裂开（2例）。接受ST治疗的患者无症状且情况良好。ACGT组术后平均插管时间为35±25天（10至60天），而ST组为14±12天（0至51天）。平均住院时间分别为292±271天（21至563天）和24±13天（7至63天）。平均随访时间为28±14个月（3至94个月）。
长节段先天性气管狭窄手术的失败率和并发症发生率很高，对预后有重大影响。治疗应由训练有素且积极性高的团队在多学科基础上进行。滑动气管成形术似乎是更好的选择，不过还应开展进一步的多中心研究。
