Antón-Pacheco Juan L, Cabezalí Daniel, Tejedor Raquel, López María, Luna Carmen, Comas Juan V, de Miguel Eduardo
Pediatric Airway Unit and Division of Pediatric Surgery, Pediatric Institute of the Heart, Doce de Octubre, University Hospital, Madrid, Spain.
Eur J Cardiothorac Surg. 2008 Jun;33(6):1069-75. doi: 10.1016/j.ejcts.2008.01.034. Epub 2008 Mar 4.
Tracheobronchial obstruction is infrequent in the pediatric age group but it is associated with significant morbidity and mortality. The purpose of this study is to review the results of a single institution experience with endoscopic stent placement in children with benign tracheobronchial obstruction, and with special concern on safety and clinical effectiveness.
Twenty-one patients with severe airway stenosing disease in which stent placement was performed between 1993 and 2006. Inclusion criteria according to the clinical status were: failure to wean from ventilation, episode of apnea, frequent respiratory infections (>3 pneumonia/year), and severe respiratory distress. Additional criteria for stent placement were: failure of surgical treatment, bronchomalacia, and tracheomalacia refractory to previous tracheostomy. Selection of the type of stent depended on the site of the lesion, the patient's age, and the stent availability when time of presentation. The following variables were retrospectively evaluated: age, type of obstruction, associated malformations, stent properties, technical and clinical success, complications and related reinterventions, outcome and follow-up period.
Thirty-three stents were placed in the trachea (n=18) and/or bronchi (n=15) of 21 patients with a median age of 6 months (range, 9 days-19 years). Etiology of the airway obstruction included severe tracheomalacia and/or bronchomalacia in 19 cases (90%), and postoperative tracheal stenosis in two. Twelve children had a total of 20 balloon-expandable metallic stents placed, and 10 had 13 silicone-type stents (one patient had both). In nine patients (42%) more than one device was placed. Stent positioning was technically successful in all but one patient. Clinical improvement was observed in 18 patients (85%) but complications occurred in five of them (27%). Eight patients died during follow-up but only in one case it was related to airway stenting. Thirteen patients (62%) are alive and in good condition with a mean follow-up of 39 months (1-13.8 years).
Although the results were based on a small series, placement of stents in the pediatric airway to treat tracheobronchial obstruction seems to be safe and effective. Stenting is a satisfactory therapeutic option when other procedures have failed or are not indicated.
气管支气管阻塞在儿童年龄组中并不常见，但它与显著的发病率和死亡率相关。本研究的目的是回顾一家机构对患有良性气管支气管阻塞的儿童进行内镜支架置入的经验结果，特别关注安全性和临床有效性。
1993年至2006年间对21例患有严重气道狭窄疾病的患者进行了支架置入。根据临床状况的纳入标准为：无法撤机、呼吸暂停发作、频繁呼吸道感染（>3次肺炎/年）以及严重呼吸窘迫。支架置入的其他标准为：手术治疗失败、支气管软化和气管软化对先前气管切开术无效。支架类型的选择取决于病变部位、患者年龄以及就诊时支架的可用性。对以下变量进行回顾性评估：年龄、阻塞类型、相关畸形、支架特性、技术和临床成功率、并发症及相关再次干预、结果和随访期。
在21例患者的气管（n = 18）和/或支气管（n = 15）中置入了33个支架，中位年龄为6个月（范围为9天至19岁）。气道阻塞的病因包括19例（90%）严重气管软化和/或支气管软化，以及2例术后气管狭窄。12名儿童共置入了20个球囊扩张金属支架，10名儿童置入了13个硅酮类支架（1名患者两种支架都置入了）。9例患者（42%）置入了不止一个装置。除1例患者外，支架定位在技术上均成功。18例患者（85%）观察到临床改善，但其中5例（27%）出现了并发症。8例患者在随访期间死亡，但仅1例与气道支架置入有关。13例患者（62%）存活且状况良好，平均随访39个月（1至13.8年）。
尽管结果基于一个小样本系列，但在儿童气道中置入支架治疗气管支气管阻塞似乎是安全有效的。当其他程序失败或不适用时，支架置入是一种令人满意的治疗选择。
