Hebra A, Powell D D, Smith C D, Othersen H B
Division of Pediatric Surgery, Medical University of South Carolina, Charleston 29425.
J Pediatr Surg. 1991 Aug;26(8):957-61. doi: 10.1016/0022-3468(91)90843-i.
Strictures of the trachea traditionally have been dilated by antegrade bouginage. This method not only dilates but imparts a shearing force to the wall of the trachea. The resultant trauma may contribute to further scarring and aggravation of the stricture. We report a 15-year experience with 37 patients and 158 tracheal dilatations using balloon catheters that impart only radially directed forces and can be precisely placed and gradually inflated. Various adjunctive techniques have been performed, including: (1) electrocautery of granulation tissue; (2) parenteral and local use of steroids; and (3) intraluminal stenting after dilation. Recent experience indicates that this combination of methods is important in improving patient outcome. The principal indications for balloon tracheoplasty include acquired tracheal stenosis from various causes, and congenital subglottic stenosis. Almost all patients received some immediate benefit from balloon tracheoplasty. Fifty-four percent of the patients achieved long-term improvement (with a minimum follow-up of 2 months). Additionally, 10 of 20 children who had been unable to previously tolerate removal of an indwelling tracheostomy tube proceeded to extubation. We have had poor success in treating bronchial and glottic stenosis. Endoscopically directed hydrostatic balloon tracheoplasty is a safe and effective method for the treatment of tracheal stenosis of varying causes. Multiple dilatations are required that gradually improve the character of the tracheal lumen. In selected cases, the procedure may delay or avoid the need for an open tracheoplasty.
传统上，气管狭窄是通过顺行探条扩张术来治疗的。这种方法不仅会扩张气管，还会对气管壁施加剪切力。由此产生的创伤可能会导致进一步的瘢痕形成和狭窄加重。我们报告了15年中对37例患者进行158次气管扩张的经验，使用的是仅施加径向力、可精确放置并能逐渐充气的球囊导管。还实施了各种辅助技术，包括：（1）对肉芽组织进行电灼；（2）胃肠外和局部使用类固醇；（3）扩张后进行腔内支架置入。最近的经验表明，这种方法的联合应用对改善患者预后很重要。球囊气管成形术的主要适应证包括各种原因引起的后天性气管狭窄和先天性声门下狭窄。几乎所有患者都从球囊气管成形术中获得了一些即时益处。54%的患者实现了长期改善（最短随访2个月）。此外，20名此前无法耐受拔除留置气管造口管的儿童中有10名成功拔管。我们在治疗支气管和声门狭窄方面效果不佳。内镜引导下的水压球囊气管成形术是治疗各种原因引起的气管狭窄的一种安全有效的方法。需要进行多次扩张，以逐渐改善气管腔的状况。在某些情况下，该手术可能会延迟或避免进行开放性气管成形术。
