Varlet F, Chavrier Y, Rayet I, Prades J M, Tardieu D
Service de chirurgie pédiatrique, hôpital Nord, CHRU, Saint-Etienne, France.
Pediatrie. 1993;48(10):719-25.
We report two cases of localized tracheomalacia, one associated with esophageal atresia, and one isolated. The pathophysiology explains that the symptoms are more important during or shortly after eating, the alimentary bowl crushing the trachea against the aorta, or the innominate artery. The exact cause of tracheomalacia is unknown. Esophageal atresia is frequently associated. The tracheal compression is more often due to the innominate artery, because its origin is located on the left side of the trachea in infants. The aorta or a vascular anomaly are rarely implicated. The symptoms of tracheomalacia are largely due to airway obstruction during expiration: stridor, baking cough, and the life-threatening "dying spell". For diagnosis, the endoscopy is the most important investigation. Among the many methods of treatment which have been proposed, the aortopexy appears to be the technique giving the best results. A single acute apneic attack is an absolute indication for surgery. It is also important to rule out severe gastroesophageal reflux, which can produce the same symptoms.
我们报告两例局限性气管软化症,一例与食管闭锁相关,另一例为孤立性。其病理生理学解释了为何在进食期间或进食后不久症状更为明显,即消化道将气管压向主动脉或无名动脉。气管软化的确切病因尚不清楚。食管闭锁常与之相关。气管受压更多是由于无名动脉,因为在婴儿中其起源位于气管左侧。主动脉或血管异常很少涉及。气管软化的症状主要是由于呼气时气道阻塞:喘鸣、犬吠样咳嗽以及危及生命的“濒死发作”。对于诊断,内镜检查是最重要的检查方法。在已提出的众多治疗方法中,主动脉固定术似乎是效果最佳的技术。单次急性呼吸暂停发作是手术的绝对指征。排除严重胃食管反流也很重要,因为它可产生相同症状。