先天性气管狭窄患者的气管过度长度。

Excessive Tracheal Length in Patients With Congenital Tracheal Stenosis.

机构信息

Department of Radiology and Medical Imaging, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

Department of Pediatrics, National Taiwan University Hospital, National Taiwan University College of Medicine, Taipei, Taiwan.

出版信息

Ann Thorac Surg. 2019 Jul;108(1):138-145. doi: 10.1016/j.athoracsur.2019.01.059. Epub 2019 Mar 5.

DOI:10.1016/j.athoracsur.2019.01.059

PMID:30849334

Abstract

BACKGROUND

Slide tracheoplasty is the preferred approach for treating long-segment congenital tracheal stenosis (CTS). However, little research has been conducted on the tracheobronchial anatomy before and after slide tracheoplasties in patients with CTS.

METHODS

We reviewed 23 patients with CTS who received slide tracheoplasties. We measured the intrathoracic tracheal length and the carina angle from computed tomography images. To account for each patient's body size, we divided the intrathoracic tracheal length by the length of the thorax to obtain the trachea-thorax ratio (TTR). These measurements were used to compare patients before and after slide tracheoplasties as well as normal control subjects.

RESULTS

Two patients had upper tracheal CTS and 21 patients had lower tracheal CTS. For the 21 patients with lower tracheal stenosis, their TTRs before slide tracheoplasty were 0.42 ± 0.04, which were significantly larger than those of the control subjects (0.32 ± 0.04; p < 0.0001). After slide tracheoplasty, the TTR was 0.32 ± 0.04, similar to the control TTRs (p = 0.94). The carina angle was significantly wider in the 21 patients than in the control subjects (120.7 ± 11.7 degrees versus 86.4 ± 13.1 degrees; p < 0.0001). After slide tracheoplasty, the carina angle was significantly narrower (from 120.7 ± 11.7 degrees to 92.2 ± 15.2 degrees; p < 0.0001), which was similar to control subjects.

CONCLUSIONS

The trachea was longer and the carina angle wider in patients with lower tracheal CTS than in control subjects. Excessive tracheal length is favorable for slide tracheoplasty. Slide tracheoplasty not only corrects CTS, but also restores tracheobronchial morphology.

摘要

背景

滑动气管成形术是治疗长段性先天性气管狭窄（CTS）的首选方法。然而，对 CTS 患者滑动气管成形术前后的支气管解剖结构的研究较少。

方法：我们回顾了 23 例接受滑动气管成形术的 CTS 患者。我们从 CT 图像上测量胸内气管长度和隆突角。为了考虑每个患者的身体尺寸，我们将胸内气管长度除以胸部长度，以获得气管 -胸部比（TTR）。这些测量值用于比较滑动气管成形术前后的患者以及正常对照组。

结果：两例患者为上气管 CTS，21 例患者为下气管 CTS。对于 21 例下气管狭窄患者，滑动气管成形术前的 TTR 为 0.42 ± 0.04，显著大于对照组（0.32 ± 0.04；p < 0.0001）。滑动气管成形术后，TTR 为 0.32 ± 0.04，与对照组 TTR 相似（p = 0.94）。21 例患者的隆突角显著宽于对照组（120.7 ± 11.7 度对于 86.4 ± 13.1 度；p < 0.0001）。滑动气管成形术后，隆突角显著变窄（从 120.7 ± 11.7 度到 92.2 ± 15.2 度；p < 0.0001），与对照组相似。

结论：下气管 CTS 患者的气管较长，隆突角较宽。过度的气管长度有利于滑动气管成形术。滑动气管成形术不仅可矫正 CTS，还可恢复支气管解剖结构。