Antón-Pacheco Juan L, Comas Juan V, Luna Carmen, Benavent María Isabel, López María, Ramos Victoria, Méndez M Dolores
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain
Pediatric Airway Unit and Pediatric Surgery Division, Department of Pediatrics, Hospital U. 12 de Octubre, Universidad Complutense, Madrid, Spain.
Eur J Cardiothorac Surg. 2014 Aug;46(2):280-5; discussion 285. doi: 10.1093/ejcts/ezt617. Epub 2014 Jan 20.
This study focuses on the different surgical and endoscopical treatment alternatives when dealing with severe complications after slide tracheoplasty (STP).
Retrospective study of patients with symptomatic congenital tracheal stenosis (CTS) admitted to a single institution, between January 1997 and January 2013, surgically treated by means of STP. The following variables were evaluated: demographics, preoperative tracheal stenosis characteristics, associated anomalies and outcome measures.
Cohort included 14 patients (8 males and 6 females) with a mean age of 8.7 months when treated (range, 1-43 m). Eleven patients (78%) showed a long segment CTS (>30% of total tracheal length) and 9 (64%) had associated cardiac or great vessel anomalies (left pulmonary artery sling). Three patients (21%) showed severe postoperative complications that required significant airway reintervention: tracheal resection of a restenotic segment, laser division with balloon dilatation of a residual stenosis and placement of a biodegradable endotracheal stent in an extensive tracheal narrowing. All patients are in good clinical condition with a mean follow-up of 6.3 years (range, 2 months to 16 years).
STP has become the procedure of choice when dealing with CTS. Although it shows clear advantages compared with other surgical techniques, severe and difficult to manage complications may occur. Surgeons involved in their treatment should be familiar with diverse surgical and endoscopical procedures. Biodegradable airway stenting is a new and promising technique when long and severe post-surgical tracheal stenosis is present.
本研究聚焦于滑动气管成形术（STP）后严重并发症的不同外科手术及内镜治疗方案。
对1997年1月至2013年1月间在单一机构收治的有症状的先天性气管狭窄（CTS）患者进行回顾性研究，这些患者接受了STP手术治疗。评估了以下变量：人口统计学资料、术前气管狭窄特征、相关异常情况及结局指标。
该队列包括14例患者（8例男性和6例女性），治疗时平均年龄为8.7个月（范围1 - 43个月）。11例患者（78%）表现为长段CTS（超过气管总长度的30%），9例（64%）伴有心脏或大血管异常（左肺动脉吊带）。3例患者（21%）出现严重术后并发症，需要进行重大气道再次干预：切除再狭窄段气管、激光切开并球囊扩张残余狭窄以及在广泛气管狭窄处放置可生物降解气管支架。所有患者临床状况良好，平均随访6.3年（范围2个月至16年）。
STP已成为治疗CTS的首选术式。尽管与其他外科技术相比它具有明显优势，但仍可能发生严重且难以处理的并发症。参与治疗的外科医生应熟悉各种外科手术及内镜操作。当出现长段且严重的术后气管狭窄时，可生物降解气道支架置入是一种新的且有前景的技术。
