Department of Otolaryngology-Head and Neck Surgery, University of Minnesota, Minneapolis, Minnesota, USA.
Laryngoscope. 2011 Dec;121(12):2665-71. doi: 10.1002/lary.22355.
OBJECTIVES/HYPOTHESIS: The objective of this study was to describe the long-term outcomes of tracheoplasty for distal tracheal stenosis, demonstrate the utility of cardiopulmonary bypass for intraoperative airway management, and compare perioperative morbidity and mortality of slide tracheoplasty for distal tracheal stenosis to costochondral graft, and resection with end-to-end anastomosis.
Retrospective chart review.
A retrospective chart review of all patients undergoing tracheoplasty for distal obstruction and also requiring the use of cardiopulmonary bypass for intraoperative airway management from 1994 to 2009 was performed. The setting for the study was a tertiary care children's hospital.
A total of 11 patients, aged 1 month to 12 years, were identified. Four patients underwent slide tracheoplasty, two had end-to-end anastomosis, and five had costochondral graft. Average cardiopulmonary bypass time was 120 minutes, 60 minutes, and 63 minutes, respectively. The only complication of cardiopulmonary bypass was a superficial wound infection. There was one late death due to airway obstruction after repair of severe cardiac anomalies. The numbers of bronchoscopies required for resolution of granulation tissue in the slide tracheoplasty and end-to-end anastomosis groups were less than for the cartilage graft group. Three patients in the cartilage graft group required tracheostomy, and one remained tracheostomy dependent at last follow-up. None in the slide tracheoplasty or end-to-end anastomosis groups required a tracheostomy during management.
Improvements in operative techniques and perioperative management have led to significant decreases in morbidity and mortality. At our institution, slide tracheoplasty has become the preferred technique for all except very short segment stenosis, and cardiopulmonary bypass is used in all cases involving the distal trachea.
目的/假设：本研究的目的是描述远端气管狭窄气管成形术的长期结果，展示体外循环在术中气道管理中的应用，并比较远端气管狭窄的滑动气管成形术与肋软骨移植、切除与端端吻合术的围手术期发病率和死亡率。
回顾性图表回顾。
对 1994 年至 2009 年间所有因远端气道阻塞而行气管成形术且术中需要体外循环进行气道管理的患者进行回顾性图表回顾。该研究的地点是一家三级保健儿童医院。
共发现 11 例年龄 1 个月至 12 岁的患者。4 例患者行滑动气管成形术，2 例行端端吻合术，5 例行肋软骨移植术。平均体外循环时间分别为 120 分钟、60 分钟和 63 分钟。体外循环唯一的并发症是浅表伤口感染。有 1 例患者因修复严重心脏畸形后气道阻塞而晚期死亡。滑动气管成形术和端端吻合术组解决肉芽组织所需的支气管镜检查次数少于软骨移植组。软骨移植组有 3 例患者需要气管切开，1 例患者在最后一次随访时仍依赖气管切开。滑动气管成形术或端端吻合术组在治疗过程中均无需行气管切开术。
手术技术和围手术期管理的改进显著降低了发病率和死亡率。在我们的机构中，滑动气管成形术已成为所有非非常短段狭窄的首选技术，所有涉及远端气管的病例均使用体外循环。
