Department of Pediatrics, Stanford University, Palo Alto, California.
Department of Otolaryngology, Head and Neck Surgery and the LPCH Stanford Pediatric Aerodigestive Program, Stanford University, Palo Alto, California.
Pediatr Pulmonol. 2017 Dec;52(12):1599-1604. doi: 10.1002/ppul.23732. Epub 2017 May 15.
Children with Tetralogy of Fallot, Pulmonary Atresia, and Major Aortopulmonary Collaterals (TOF/PA/MAPCAs) undergoing unifocalization surgery are at risk for developing more postoperative respiratory complications than children undergoing other types of congenital heart surgery. Bronchoscopy is used in the perioperative period for diagnostic and therapeutic purposes. In this study, we describe bronchoscopic findings and identify factors associated with selection for bronchoscopy.
Retrospective case-control.
All patients with TOF/PA/MAPCAs who underwent unifocalization surgery from September 2005 through March 2016 were included. Patients who underwent bronchoscopy in the perioperative period were compared to a randomly selected cohort of 172 control patients who underwent unifocalization without bronchoscopy during the study period.
Forty-three children underwent perioperative bronchoscopy at a median of 9 days postoperatively. Baseline demographics were similar in bronchoscopy patients and controls. Patients who underwent bronchoscopy were more likely to have a chromosome 22q11 deletion and were more likely have undergone unifocalization surgery without intracardiac repair. These patients had a longer duration of mechanical ventilation, ICU duration, and length of hospitalization. Abnormalities were detected on bronchoscopy in 35 patients (81%), and 20 (35%) of bronchoscopy patients underwent a postoperative intervention related to abnormalities identified on bronchoscopy.
Bronchoscopy is a useful therapeutic and diagnostic instrument for children undergoing unifocalization surgery, capable of identifying abnormalities leading to an additional intervention in over one third of patients. Special attention should be given to children with a 22q11 deletion to expedite diagnosis and intervention for possible airway complications.
接受四联症根治术、肺动脉闭锁合并主要体肺侧支循环（TOF/PA/MAPCAs）的患儿比接受其他类型先天性心脏病手术的患儿更有可能在术后出现更多的呼吸系统并发症。支气管镜检查在围手术期用于诊断和治疗目的。在这项研究中，我们描述了支气管镜检查的发现，并确定了与支气管镜检查选择相关的因素。
回顾性病例对照研究。
所有 2005 年 9 月至 2016 年 3 月期间接受四联症根治术的 TOF/PA/MAPCAs 患儿均被纳入研究。在围手术期接受支气管镜检查的患者与在研究期间未接受支气管镜检查而接受四联症根治术的 172 例随机对照患儿进行比较。
43 例患儿在术后 9 天中位数时接受了围手术期支气管镜检查。支气管镜检查患儿和对照组的基线人口统计学数据相似。接受支气管镜检查的患儿更有可能存在 22q11 缺失，并且更有可能在未进行心内修复的情况下接受四联症根治术。这些患儿的机械通气时间、ICU 持续时间和住院时间均较长。35 例（81%）患儿在支气管镜检查中发现异常，20 例（35%）支气管镜检查患儿因支气管镜检查中发现的异常而接受了术后干预。
支气管镜检查是接受四联症根治术患儿的一种有用的治疗和诊断工具，能够识别导致超过三分之一患儿需要额外干预的异常。对于 22q11 缺失的患儿应特别关注，以加快可能的气道并发症的诊断和干预。
