Dave Sumit, Currie Bruce G
Department of Paediatric Surgery, Sydney Children's Hospital, Randwick NSW 2031, Australia.
J Pediatr Surg. 2006 Mar;41(3):533-7. doi: 10.1016/j.jpedsurg.2005.11.064.
Aortopexy is the accepted operative treatment for severe and localized tracheomalacia (TM). The standard surgical approach involves a left anterior thoracotomy, often under bronchoscopic control. We report the results of aortopexy in 28 children with severe and localized TM; 12 had a left lateral muscle-sparing approach and one had a thoracoscopic aortopexy.
Retrospective review of patient notes was performed to note the indications, investigation findings, and postoperative course after aortopexy.
The median age at aortopexy was 5 months. The indications included acute life-threatening events in 22, failure to extubate in 5, and recurrent pneumonia in 1. Fifteen had associated esophageal atresia and 13 had primary TM. Symptoms of TM were abolished in 26 of the 28 patients after aortopexy.
Aortopexy is a safe and reliable procedure to treat localized intrathoracic TM presenting with acute life-threatening events. It is important to exclude associated problems such as vascular rings and to ensure that the tracheomalacic portion is segmental and does not significantly involve the main bronchi. The lateral muscle-sparing thoracotomy provides good access and is more cosmetic than the standard anterior approach. We would attempt the thoracoscopic approach in older infants and children.
主动脉固定术是治疗严重局限性气管软化症（TM）公认的手术方法。标准手术入路包括左前开胸术，通常在支气管镜引导下进行。我们报告了28例严重局限性TM患儿行主动脉固定术的结果；其中12例行左侧保留肌肉入路，1例行胸腔镜下主动脉固定术。
对患者病历进行回顾性分析，记录主动脉固定术的适应证、检查结果及术后病程。
主动脉固定术的中位年龄为5个月。适应证包括22例急性危及生命事件、5例拔管失败和1例复发性肺炎。15例合并食管闭锁，13例为原发性TM。28例患者中26例在主动脉固定术后TM症状消失。
主动脉固定术是治疗伴有急性危及生命事件的局限性胸内TM的一种安全可靠的方法。排除血管环等相关问题并确保气管软化部分为节段性且不显著累及主支气管很重要。保留肌肉的外侧开胸术提供了良好的手术视野，且比标准前入路更美观。我们将尝试对年龄较大的婴儿和儿童采用胸腔镜入路。
