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前心包气管成形术治疗长段气管狭窄:长期结果。

Anterior pericardial tracheoplasty for long-segment tracheal stenosis: long-term outcomes.

机构信息

Section of Cardiothoracic Surgery, Indiana University School of Medicine, 545 Barnhill Dr, EH 215, Indianapolis, IN 46202-5123, USA.

出版信息

J Thorac Cardiovasc Surg. 2010 Jan;139(1):18-23; discussion 23-5. doi: 10.1016/j.jtcvs.2009.09.040. Epub 2009 Nov 11.

Abstract

OBJECTIVE

Although several techniques have been described for the treatment of tracheal stenosis, including slide tracheoplasty, tracheal autograft, rib grafting, and use of a pericardial patch, the optimal repair remains controversial because of a lack of long-term follow-up data. The purpose of this study is to examine the long-term results of anterior pericardial tracheoplasty.

METHODS

To assess the long-term outcomes of patients who underwent repair of tracheal stenosis with anterior pericardial tracheoplasty, we reviewed the case histories of 26 consecutive patients (1984-present). All but 5 had long-segment tracheal stenosis with more than 10 complete tracheal rings. Twenty-one had significant cardiac disease, and 10 had their cardiac lesions repaired at the time of their tracheoplasty. The median age was 6 months (range, 2 days-25 years). All patients underwent anterior pericardial tracheoplasty through a median sternotomy during normothermic cardiopulmonary bypass. We have previously described our tracheoplasty technique. An average of 14 tracheal rings (range, 5-22) was divided anteriorly, and a patch of fresh autologous pericardium was used to enlarge the trachea to 1.5 times the predicted diameter for age and weight.

RESULTS

There were 3 hospital deaths (at 1, 2, and 7 months, respectively) and 2 late deaths (at 2 and 13 years postoperatively, respectively). No deaths were related to airway obstruction. Two survivors required tracheostomy postoperatively, one after formation of granulation tissue and stenosis and the other after failure to wean from mechanical ventilation. All survivors remain asymptomatic, with minimal to no evidence of airway obstruction. Median follow-up is 11 years (range, 3 months-22 years).

CONCLUSION

Anterior pericardial tracheoplasty for tracheal stenosis provides excellent results in the majority of patients at long-term follow-up.

摘要

目的

尽管已经有几种技术被用于治疗气管狭窄,包括滑动气管成形术、气管自体移植、肋骨移植和心包补片的使用,但由于缺乏长期随访数据,最佳修复方法仍存在争议。本研究旨在检查前心包气管成形术的长期结果。

方法

为了评估接受前心包气管成形术修复气管狭窄的患者的长期结果,我们回顾了 26 例连续患者(1984 年至今)的病史。除 5 例外,所有患者均有 10 个以上完整气管环的长段气管狭窄。21 例有严重的心脏病,10 例在气管成形术时同时修复了心脏病变。中位年龄为 6 个月(范围,2 天-25 岁)。所有患者均在常温体外循环下通过正中胸骨切开术接受前心包气管成形术。我们之前已经描述过我们的气管成形术技术。平均有 14 个气管环(范围,5-22)在前部被切开,并用新鲜的自体心包片将气管扩大到预测的年龄和体重的 1.5 倍。

结果

有 3 例患者在住院期间死亡(分别在第 1、2 和 7 个月),2 例患者在术后晚期死亡(分别在第 2 和 13 年)。没有死亡与气道阻塞有关。2 例存活者术后需要行气管造口术,1 例是由于肉芽组织形成和狭窄,另 1 例是由于无法从机械通气中脱机。所有存活者均无症状,气道阻塞的证据很少或没有。中位随访时间为 11 年(范围,3 个月-22 年)。

结论

在前心包气管成形术治疗气管狭窄中,大多数患者在长期随访中取得了优异的结果。

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