van Son J A, Julsrud P R, Hagler D J, Sim E K, Pairolero P C, Puga F J, Schaff H V, Danielson G K
Division of Thoracic and Cardiovascular Surgery, Mayo Clinic, Rochester, Minnesota 55905.
Mayo Clin Proc. 1993 Nov;68(11):1056-63. doi: 10.1016/s0025-6196(12)60898-2.
From 1947 through 1992, 37 Mayo Clinic patients underwent operation for the relief of tracheoesophageal obstruction that resulted from vascular rings and related entities. Of the 37 patients, 18 had a double aortic arch, 11 had a right aortic arch with an aberrant left subclavian artery, 4 had a left aortic arch with an aberrant right subclavian artery, 2 had a pulmonary artery sling, 1 had a right aortic arch with mirror-image branching and a left ligamentum arteriosum, and 1 had a left aortic arch, a right descending aorta, and a right ductus arteriosus. Symptoms consisted of stridor, recurrent respiratory infections, and dysphagia. The anomaly was approached through a left thoracotomy in 31 patients, through a right thoracotomy in 4, and through a median sternotomy in 2. Only one early postoperative death (3%) and no late deaths occurred. At long-term follow-up (maximal duration, 45 years), three patients had residual symptomatic tracheomalacia, one of whom required right middle and lower lobectomy for recurrent pneumonia. Magnetic resonance imaging is the imaging technique of choice for accurate delineation of the vascular and tracheal anatomy. When patients are symptomatic, vascular ring should be repaired. The surgical risk is minimal, and the long-term results are excellent.
从1947年到1992年，梅奥诊所的37例患者接受了手术，以缓解由血管环及相关病变导致的气管食管梗阻。在这37例患者中，18例有双主动脉弓，11例有右主动脉弓伴左锁骨下动脉异常，4例有左主动脉弓伴右锁骨下动脉异常，2例有肺动脉吊带，1例有右主动脉弓伴镜像分支及左动脉韧带，1例有左主动脉弓、右位降主动脉及右动脉导管。症状包括喘鸣、反复呼吸道感染和吞咽困难。31例患者通过左胸切口进行手术，4例通过右胸切口，2例通过胸骨正中切口。术后仅1例早期死亡（3%），无晚期死亡病例。长期随访（最长45年）时，3例患者有残留症状性气管软化，其中1例因反复肺炎需要行右中、下肺叶切除术。磁共振成像（MRI）是准确描绘血管和气管解剖结构的首选成像技术。当患者出现症状时，应修复血管环。手术风险极小，长期效果良好。
