Elliott M J, Haw M P, Jacobs J P, Bailey C M, Evans J N, Herberhold C
Cardiothoracic Unit, Great Ormond Street Hospital for Children, London, England.
Eur J Cardiothorac Surg. 1996;10(9):707-12. doi: 10.1016/s1010-7940(96)80328-9.
We report the use of cadaveric human tracheal homograft in the treatment of severe long segment congenital tracheal stenosis in children.
Five children (aged 5 months-8 years) with severe life-threatening airway obstruction due to long segment congenital tracheal stenosis had failed conventional management. All were ventilator dependent or rapidly deteriorating at the time of surgery, two were on extracorporeal membrane oxygenation, and no alternative therapy was available. The stenosed trachea was removed and the posterior trachealis muscle left in situ when possible. Surgical technique involved the use of cardiopulmonary bypass in four of five cases. Stored cadaveric tracheal homograft tissue was shaped and inserted over a silastic intra-luminal stent which was kept in place for up to 3 months. Regular bronchoscopy was necessary postoperatively to clear granulation tissue, which resolved on removal of the stent.
Four patients are all now without stents, intubation or tracheostomy. Three are without airway problems 16, 14, and 9 months after surgery and one attends for occasional dilatation of a distal tracheal stenosis, but is now at home despite other severe multiple congenital problems. One patient presented with complete disruption of the trachea and mediastinal sepsis and was supported on extracorporeal membrane oxygenation prior to surgery; this patient eventually died of airway failure and sepsis.
The application of cadaveric human tracheal homograft to congenital tracheal stenosis is novel. Its use in five children who would otherwise have died has provided an extra therapy in an extremely difficult group of patients.
我们报告使用尸体人气管同种异体移植治疗儿童严重长节段先天性气管狭窄。
五名儿童（年龄5个月至8岁）因长节段先天性气管狭窄导致严重危及生命的气道阻塞，常规治疗失败。所有患儿在手术时均依赖呼吸机或病情迅速恶化，两名患儿接受体外膜肺氧合治疗，且无其他替代疗法可用。切除狭窄的气管，尽可能保留气管后肌原位。五例中有四例手术采用体外循环技术。将储存的尸体气管同种异体移植组织塑形后，置于硅橡胶腔内支架上，支架保留长达3个月。术后需定期进行支气管镜检查以清除肉芽组织，去除支架后肉芽组织消退。
四名患者目前均无需支架、插管或气管切开。三名患者在术后16、14和9个月无气道问题，一名患者因远端气管狭窄偶尔需要扩张治疗，但尽管存在其他严重的多发先天性问题，目前已在家中。一名患者出现气管完全断裂和纵隔感染，术前接受体外膜肺氧合支持；该患者最终死于气道衰竭和感染败血症。
尸体人气管同种异体移植应用于先天性气管狭窄是一种新方法。在五名原本可能死亡的儿童中使用该方法，为这一极难治疗的患者群体提供了一种额外的治疗手段。
