Department of Otolaryngology & Communication Enhancement, Boston Children's Hospital, Boston, Massachusetts.
Department of Surgery, Boston Children's Hospital, Boston, Massachusetts.
JAMA Otolaryngol Head Neck Surg. 2019 Mar 1;145(3):265-275. doi: 10.1001/jamaoto.2018.3276.
Tracheobronchomalacia (TBM) describes an increased collapsibility of the trachea and bronchi that is greatest on forced expiration. A broad term, TBM encompasses intrinsic tracheal weakness, some forms of tracheal deformation, and extrinsic compression. Tracheobronchomalacia is the most common congenital tracheal anomaly, affecting 1 in 2100 children. Tracheobronchomalacia is often associated with recurrent and prolonged respiratory tract infections, can lead to chronic lung disease, and can be fatal in its most severe form. Tracheobronchomalacia is often associated with other congenital anomalies and syndromes.
There is a paucity of information on TBM treatment in the modern otolaryngology literature. The primary treatment modalities described include tracheotomy, tracheal stents, and anterior aortopexy. In this review, a new TBM classification scheme and new treatment strategies are introduced to the otolaryngology literature. Diagnosis is made through history and physical examination, dynamic airway computed tomography, and dynamic 3-phase tracheobronchoscopy. Medical management includes nebulizer treatments, minimal use of inhaled corticosteroids, gastroesophageal reflux disease therapy, and continuous positive airway pressure. Surgical techniques, including anterior and posterior tracheobronchopexy and anterior and posterior aortopexy, are described.
Tracheobronchomalacia is an entity of relevance to pediatric otolaryngologists and should be considered as being associated with respiratory distress, stridor, cough, recurrent pneumonia, or feeding difficulties, especially in children with syndromes or other congenital anomalies. A multidisciplinary approach to these patients is essential. A classification scheme facilitates discussion of individual patients among health care professionals and guides appropriate management. Novel surgical approaches for the treatment of TBM, including anterior and posterior tracheopexy and aortopexy, may be considered in management of the treatment of children with symptomatic TBM.
气管支气管软化症（TBM）描述了气管和支气管在用力呼气时的过度塌陷，这种塌陷在气管中最为明显。TBM 是一个广泛的术语，包括气管固有脆弱、某些类型的气管变形和外部压迫。TBM 是最常见的先天性气管异常，影响 1/2100 的儿童。TBM 常与反复和长期的呼吸道感染有关，可导致慢性肺部疾病，并在最严重的形式下致命。TBM 常与其他先天性异常和综合征有关。
现代耳鼻喉科学文献中关于 TBM 治疗的信息很少。描述的主要治疗方式包括气管切开术、气管支架和主动脉前固定术。在这篇综述中，一种新的 TBM 分类方案和新的治疗策略被引入耳鼻喉科学文献。通过病史和体格检查、动态气道计算机断层扫描和动态 3 相气管支气管镜检查来诊断。药物治疗包括雾化治疗、最小剂量吸入皮质类固醇、胃食管反流病治疗和持续气道正压通气。手术技术，包括前后气管支气管固定术和前后主动脉固定术，也进行了描述。
TBM 是儿科耳鼻喉科医生需要关注的实体，应考虑与呼吸困难、喘鸣、咳嗽、反复肺炎或喂养困难有关，特别是在有综合征或其他先天性异常的儿童中。对这些患者进行多学科治疗至关重要。分类方案有助于医疗保健专业人员讨论个别患者，并指导适当的管理。对于有症状的 TBM 患儿，可考虑采用包括前后气管支气管固定术和主动脉固定术在内的新型 TBM 治疗手术方法。
