Vinograd I, Klin B, Efrati Y, Barr J, Behar M, Eshel G
Department of Pediatric Surgery, Assaf Harofeh Medical Center, Sackler School of Medicine, University of Tel Aviv, Israel.
J Cardiovasc Surg (Torino). 1994 Dec;35(6 Suppl 1):7-12.
This review of 54 infants and children with airway obstruction who were treated surgically emphasizes the importance of the surgical indications with respect to various anomalies causing airway obstruction and the surgical approach to their management.
There were 4 etiologic groups of airway obstruction. Group A comprised 12 infants with subglottic stenosis; Group B--20 infants with tracheomalacia; 21 patients (Group C) with anatomic narrowing of the trachea; and 1 infant (Group D) with laceration of a main bronchus.
The surgical procedures performed included anterior laryngotracheal decompression in 12 infants, aortopexy in 19; 1 pulmonary arteriopexy; tracheal stenting with an autologous rib graft in 3 and with Marlex mesh in 1. Tracheal widening, using a free tibia autologous graft, was performed in 3 patients; transbronchoscopic excision in 12; anterior tracheal wedge resection in 4, and segmental tracheal resection and anastomosis in 1 patient. The lacerated bronchus was repaired with fine Dexon sutures.
There were no operative deaths. With respect to the original indications for surgery, there were 3 failures--2 in Group A and 1 in Group C. Two patients died from causes unrelated to the procedures--one 10 days postoperatively, and the other 3 months after surgery.
The surgical approach to tracheal obstruction in infants and children offers effective treatment, with no operative mortality, a low complication rate, and good long term survival.
对54例接受手术治疗的气道阻塞婴幼儿及儿童进行的这项综述强调了手术指征对于导致气道阻塞的各种异常情况的重要性以及针对其治疗的手术方法。
气道阻塞有4个病因组。A组包括12例声门下狭窄的婴儿；B组——20例气管软化的婴儿；21例（C组）气管解剖性狭窄的患者；以及1例（D组）主支气管撕裂的婴儿。
所施行的手术操作包括12例婴儿行前喉气管减压术，19例行主动脉固定术；1例行肺动脉固定术；3例用自体肋骨移植行气管支架置入术，1例用Marlex网行气管支架置入术。3例患者用自体游离胫骨移植行气管扩张术；12例行经支气管镜切除术；4例行气管前楔形切除术，1例患者行气管节段性切除及吻合术。撕裂的支气管用细的聚对二氧环己酮缝线修复。
无手术死亡病例。就手术的原指征而言，有3例治疗失败——A组2例，C组1例。2例患者死于与手术无关的原因——1例术后10天死亡，另1例术后3个月死亡。
婴幼儿气管阻塞的手术方法提供了有效的治疗，无手术死亡率，并发症发生率低，且长期生存率良好。
