Tracheal Team, Great Ormond Street Hospital, London, UK.
Department of Otolaryngology, Great Ormond Street Hospital, London, UK.
Eur J Cardiothorac Surg. 2018 Sep 1;54(3):585-592. doi: 10.1093/ejcts/ezy076.
Our study describes and analyses the results from aortopexy for the treatment of airway malacia in children.
Demographic data, characteristics and preoperative, operative and outcome details, including the need for reintervention, were collected for children undergoing aortopexy between 2006 and 2016.
One hundred patients [median age 8.2 months, interquartile range (IQR) 3.3-26.0 months] underwent aortopexy. Sixty-four (64%) patients had tracheomalacia (TM) only, 24 (24%) patients had TM extending into their bronchus (tracheobronchomalacia) and 11 (11%) patients had bronchomalacia. Forty-one (41%) children had gastro-oesophageal reflux disease, of which 17 (41%) children underwent a Nissen fundoplication. Twenty-eight (28%) children underwent a tracheo-oesophageal fistula repair prior to aortopexy (median 5.7 months, IQR 2.9-17.6 months). The median duration of follow-up was 5.3 years (IQR 2.9-7.5 years). Thirty-five (35%) patients were on mechanical ventilatory support before aortopexy. Twenty-seven (77%) patients could be safely weaned from ventilator support during the same admission after aortopexy (median 2 days, IQR 0-3 days). Fourteen patients required reintervention. Overall mortality was 16%. Multivariable analysis revealed preoperative ventilation (P = 0.004) and bronchial involvement (P = 0.004) to be adverse predictors of survival. Only bronchial involvement was a predictor for reintervention (P = 0.012).
Aortopexy appears to be an effective procedure in the treatment of children with severe airway malacia. Bronchial involvement is associated with adverse outcome, and other procedures could be more suitable. For the treatment of severe airway malacia with isolated airway compression, we currently recommend aortopexy to be considered.
本研究描述并分析了主动脉固定术治疗儿童气道软化症的结果。
收集了 2006 年至 2016 年期间行主动脉固定术的儿童的人口统计学数据、特征以及术前、术中和术后的详细信息，包括再次干预的需要。
100 例患者[中位年龄 8.2 个月，四分位距（IQR）3.3-26.0 个月]接受了主动脉固定术。64 例（64%）患者仅存在气管软化症（TM），24 例（24%）患者 TM 延伸至支气管（气管支气管软化症），11 例（11%）患者存在支气管软化症。41 例（41%）儿童患有胃食管反流病，其中 17 例（41%）儿童行 Nissen 胃底折叠术。28 例（28%）儿童在主动脉固定术前行气管食管瘘修补术（中位时间 5.7 个月，IQR 2.9-17.6 个月）。中位随访时间为 5.3 年（IQR 2.9-7.5 年）。35 例（35%）患者在主动脉固定术前需要机械通气支持。27 例（77%）患者在主动脉固定术后同一住院期间可安全脱离呼吸机支持（中位时间 2 天，IQR 0-3 天）。14 例患者需要再次干预。总体死亡率为 16%。多变量分析显示，术前通气（P=0.004）和支气管受累（P=0.004）是生存的不利预测因素。只有支气管受累是再次干预的预测因素（P=0.012）。
主动脉固定术似乎是治疗严重气道软化症儿童的有效方法。支气管受累与不良结局相关，其他手术可能更合适。对于单纯气道压迫引起的严重气道软化症，我们目前建议考虑行主动脉固定术。
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