Department of Cardiothoracic Surgery, Children's Hospital of Chongqing Medical University, China; Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
Ministry of Education Key Laboratory of Child Development and Disorders, China; National Clinical Research Center for Child Health and Disorders, China; China International Science and Technology Cooperation Base of Child Development and Critical Disorders, China; Chongqing Key Laboratory of Pediatrics, China; Children's Hospital of Chongqing Medical University, China.
Int J Pediatr Otorhinolaryngol. 2023 Sep;172:111691. doi: 10.1016/j.ijporl.2023.111691. Epub 2023 Jul 31.
This study aims to evaluate the outcomes of simultaneous repair for infants with long-segment congenital tracheal stenosis (LSCTS) with congenital cardiovascular defects (CCD).
We retrospectively reviewed the clinical data of infants aged less than 1 year with LSCTS and CCD who underwent simultaneous repair at Children's Hospital of Chongqing Medical University from January 2020 to March 2023. A systematic search of PubMed, Embase, and Cochrane Library for the relevant published studies that reported the simultaneous repair of CTS and CCD in infancy was conducted in March 2023. The inverse variance method of DerSimonian-Laird (D + L) was used for estimate synthesis.
A total of thirteen infants with a mean age of 5.6 ± 3.1 months and a mean weight of 6.4 ± 0.9 Kg underwent slide tracheoplasty with modified procedures and cardiovascular operations. LSCTS was diagnosed in all thirteen patients. Nine infants were ventilator dependent, and four patients were operated on due to persistent wheezing and recurrent respiratory infections. Seven patients underwent pulmonary artery sling repair, and six underwent atrial septal defect repair. All infants were repaired utilizing cardiopulmonary bypass (CPB) support. Significant complications were recorded in three patients. In-hospital deaths were seen in one case. The median tracheal minimum diameter of hospital survivors was significantly larger than the preoperative minimum diameter (p < 0.001). The mean follow-up duration was 17.1 ± 7.1 months. There was no late mortality during the follow-up. Twelve studies were included based on our search strategy. The pooled estimate of mortality in the literature was 10.9% (95%CI, 5.3%-17.7%, I = 0). The pooled estimate of airway re-interventions was 28.8% (95%CI, 14.5%-43.2%, I = 74%).
Simultaneous repair of LSCTS and CCD in infancy is safe and effective. Slide tracheoplasty with appropriate technical modifications may be valid for LSCTS repair without significant restenosis and reinterventions.
本研究旨在评估同时修复长节段先天性气管狭窄（LSCTS）合并先天性心血管缺陷（CCD）婴儿的治疗效果。
我们回顾性分析了 2020 年 1 月至 2023 年 3 月在重庆医科大学儿童医院接受 LSCTS 合并 CCD 同期修复的年龄小于 1 岁的婴儿的临床资料。2023 年 3 月，我们对PubMed、Embase 和 Cochrane Library 中关于婴儿同期修复 CTS 和 CCD 的相关已发表研究进行了系统检索。采用 DerSimonian-Laird（D+L）逆方差法进行合并效应估计。
共 13 例婴儿纳入研究，平均年龄为 5.6±3.1 个月，平均体重为 6.4±0.9kg，均采用改良滑动气管成形术和心血管手术。13 例患儿均诊断为 LSCTS，9 例患儿依赖呼吸机，4 例患儿因持续性喘息和反复呼吸道感染而接受手术治疗。7 例患儿接受了肺动脉吊带修复术，6 例患儿接受了房间隔缺损修复术。所有患儿均在体外循环（CPB）支持下进行手术。3 例患儿出现显著并发症，1 例患儿院内死亡。存活患儿出院时的气管最小直径中位数显著大于术前最小直径（p<0.001）。中位随访时间为 17.1±7.1 个月，随访期间无患儿死亡。根据检索策略，共纳入 12 项研究。文献汇总死亡率为 10.9%（95%CI，5.3%-17.7%，I=0），气道再干预的汇总估计值为 28.8%（95%CI，14.5%-43.2%，I=74%）。
婴儿 LSCTS 合并 CCD 的同期修复是安全有效的。采用适当技术改良的滑动气管成形术治疗 LSCTS 可能有效，不会出现明显的再狭窄和再干预。
