The National Medical Research Center of Children's Health, Lomonosovskiy Prospect, 2/1, Moscow, 119991, Russia.
State Budgetary Educational Institution of Higher Professional Education, Russian National Research Medical University Named After N.I. Pirogov, Ministry of Health of Russia, Moscow, Russia.
J Pediatr Surg. 2023 Apr;58(4):624-628. doi: 10.1016/j.jpedsurg.2022.12.022. Epub 2022 Dec 22.
Complete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area.
We have performed slide tracheoplasty in 12 children during the period of 2019-2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight - 8,04 ± 4,75 kg (3-20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length - from 40 to 70% of the trachea length.
Slide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects - 1, aberrant subclavian artery -1). 5 children underwent one-stage correction of VSD: plastic VSD -1; left pulmonary artery reimplantation - 3; subclavian artery reimplantation - 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development.
Children with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5-2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management.
III.
完全性气管环是一种罕见的畸形，每 10 万例活产儿中发生 1 例。它是一种罕见的、孤立的气管或气管支气管异常，由于软骨生长异常导致完全性环状结构形成，常导致气道狭窄。滑动气管成形术，最初由 Tsang 等人描述，由 Grillo 等人推广，重叠狭窄的气管段，缩短气管本身，从而使狭窄区域的周长和直径加倍。
我们在中心胸外科 2019-2021 年期间对 12 名儿童进行了滑动气管成形术。中位年龄为 15±21.1 个月（2 个月至 6 岁），中位体重为 8.04±4.75kg（3-20.7kg），气管腔从 2.5 到 3.0mm，狭窄长度从气管长度的 40%到 70%不等。
7 例采用中心静脉-动脉体外膜肺氧合（ECMO）进行滑动气管成形术，5 例采用体外循环。5 例患儿合并心脏病（3 例肺动脉吊带，1 例室间隔缺损，1 例锁骨下动脉异常）。5 例患儿同期行 VSD 矫治术：塑料 VSD 1 例；左肺动脉再植入 3 例；锁骨下动脉再植入 1 例。所有患儿术后均需机械通气 4.3±2.78 天。术后 16.3±5.14 天出院。10 例患者呼吸困难缓解，治疗效果满意。所有病例气管腔均增加 1.5 至 2 倍。2 例（16.6%）因脓毒症和多器官功能衰竭死亡。
完全性气管环患儿是一种非常复杂的伴有多种合并症的患儿。尽管医学取得了进步，但有时仍无法挽救这些患儿的生命。体外循环（ECMO 和旁路）的使用使我们能够安全地对气管进行重建手术，使患儿免于出现呼吸衰竭表现。如有需要，可同时矫正心脏和气管缺陷。滑动气管成形术可使气管腔至少增加 1.5-2 倍。机械通气是先天性气管狭窄管理结局的不利预测因素。
III。
