Kimura K, Soper R T, Kao S C, Sato Y, Smith W L, Franken E A
Department of Surgery, University of Iowa Hospitals and Clinics, Iowa City 52242.
J Pediatr Surg. 1990 Jul;25(7):769-72. doi: 10.1016/s0022-3468(05)80016-8.
During the period of 1 year (1988 to 1989), five infants, aged 3 weeks to 10 months, presented with recurrent respiratory distress following repair of esophageal atresia with tracheoesphageal fistula (EA/TEF). These patients had associated congenital anomalies, including right aortic arch (1), biliary atresia (1), and a long gap that required esophageal elongation by spiral myotomy (1). The patients were evaluated for tracheomalacia using cinecomputed tomography (cine-CT; C-100 Scanner, Imatron, San Francisco, CA), which provides images of eight levels (8-mm interval) simultaneously with 0.7 second time intervals of cine-CT. Dynamic studies of the trachea by cine-CT showed tracheal collapse that was most significant during expiration in the segment immediately above and at the aortic arch. These patients underwent aortosternopexy. Via a right second intercostal approach, the ascending aorta and aortic arch were lifted anteriorly using two to four sutures of 5-0 Tevdek on pledgets placed between the tunica media and adventitia of the side walls of the aorta and the adjacent sternum. Respiratory distress was significantly improved postoperatively. Preliminary experience with these patients allows us to conclude that (1) cine-CT is a useful technique for diagnosing tracheomalacia; (2) it provides objective indication for its correction by aortosternopexy; and (3) the refined technique in placing sutures on the aorta may reduce the surgical risks of aortosternopexy.
在1年期间（1988年至1989年），5名年龄在3周至10个月的婴儿在食管闭锁合并气管食管瘘（EA/TEF）修复术后出现反复呼吸窘迫。这些患者伴有先天性异常，包括右位主动脉弓（1例）、胆道闭锁（1例），以及1例因长段间隙需要通过螺旋肌切开术延长食管。使用电影计算机断层扫描（cine-CT；C-100扫描仪，Imatron，加利福尼亚州旧金山）对这些患者进行气管软化评估，该设备能以0.7秒的电影CT时间间隔同时提供八个层面（间隔8毫米）的图像。通过cine-CT对气管进行动态研究显示，气管塌陷在主动脉弓上方紧邻部位呼气时最为明显。这些患者接受了主动脉胸骨固定术。经右第二肋间入路，使用2至4根5-0 Tevdek缝线，在置于主动脉侧壁中膜与外膜之间以及相邻胸骨之间的小棉片上，将升主动脉和主动脉弓向前提起。术后呼吸窘迫明显改善。对这些患者的初步经验使我们得出结论：（1）cine-CT是诊断气管软化的有用技术；（2）它为主动脉胸骨固定术的矫正提供了客观依据；（3）在主动脉上放置缝线的精细技术可能会降低主动脉胸骨固定术的手术风险。
