Department of Anesthesiology, The Christ Hospital, Cincinnati, Ohio.
International Evidence-Based Anatomy Working Group, Krakow, Poland; Department of Human Anatomy, University of Nairobi, Nairobi, Kenya.
Ann Thorac Surg. 2021 Jul;112(1):315-325. doi: 10.1016/j.athoracsur.2020.08.060. Epub 2020 Nov 4.
The aim of this study was to determine the prevalence and anatomic features of major tracheobronchial anomalies.
Major electronic databases were systematically searched to identify eligible studies. Data were extracted and pooled into a meta-analysis. The primary outcome was the prevalence of major tracheobronchial anomalies, specifically tracheal bronchus (TB) and accessory cardiac bronchus (ACB). Secondary outcomes included the origin and types of TB and ACB.
A total of 27 studies (n = 119,695 patients) were included. A TB was present in 0.99% (95% confidence interval, 0.67 to 1.37) of patients, and an ACB was present in 0.14% (95% confidence interval, 0.09 to 0.20). The overall prevalence of TB was higher in imaging than in operative studies (1.81% vs 0.82%). It was also higher in pediatric (2.55%) than in adult studies (0.50%). Patients with other congenital anomalies were 15 times more likely to have a TB (odds ratio 14.89; 95% confidence interval, 7.09 to 31.22). The most common origin of TBs was from the trachea (81.42%), primarily from the right side (96.43%). The most common origin of ACBs was from the intermediate bronchus (74.32%). The ACBs terminated as blind-ending diverticulum in two thirds of cases.
Major tracheobronchial anomalies are present in approximately 1% of the population, although the prevalence is higher among pediatric patients and patients with accompanying congenital anomalies. Although rare, major tracheobronchial anomalies can be associated with significant respiratory morbidities and present challenges during airway management in surgical and critical care patients. Establishing a preoperative diagnosis of these variations is essential for planning and implementing an appropriate airway management strategy to minimize attendant complications.
本研究旨在确定主要气管支气管异常的患病率和解剖特征。
系统检索主要电子数据库以确定合格的研究。提取数据并汇总进行荟萃分析。主要结局是主要气管支气管异常（即气管支气管（TB）和副心支气管（ACB））的患病率。次要结局包括 TB 和 ACB 的起源和类型。
共纳入 27 项研究（n=119695 例患者）。TB 在 0.99%（95%置信区间，0.67 至 1.37）的患者中存在，ACB 在 0.14%（95%置信区间，0.09 至 0.20）的患者中存在。影像学研究中 TB 的总体患病率高于手术研究（1.81%比 0.82%）。儿科患者（2.55%）也高于成人研究（0.50%）。患有其他先天性异常的患者发生 TB 的可能性高 15 倍（优势比 14.89；95%置信区间，7.09 至 31.22）。TB 最常见的起源是气管（81.42%），主要起源于右侧（96.43%）。ACB 最常见的起源是中间支气管（74.32%）。三分之二的 ACB 以盲端憩室形式终止。
主要气管支气管异常在人群中的患病率约为 1%，但在儿科患者和伴有先天性异常的患者中患病率更高。尽管罕见，但主要气管支气管异常可与显著的呼吸系统发病率相关，并在手术和重症监护患者的气道管理中带来挑战。术前诊断这些变异对于规划和实施适当的气道管理策略以最大程度减少相关并发症至关重要。
