Jacobs J P, Elliott M J, Haw M P, Bailey C M, Herberhold C
Great Ormond Street Hospital for Children, London, United Kingdom.
J Thorac Cardiovasc Surg. 1996 Dec;112(6):1549-58; discussion 1559-60. doi: 10.1016/S0022-5223(96)70014-4.
Tracheal stenosis can be a life-threatening problem in children. Long-segment tracheal stenosis and recurrent tracheal stenosis are especially problematic. Tracheal homograft reconstruction represents a novel therapeutic modality for these patients.
Cadaveric trachea is harvested, fixed in formalin, washed in thimerosal (Methiolate), and stored in acetone. The stenosed tracheal segment is opened to widely patent segments proximally and distally. The anterior cartilage is excised and the posterior trachealis muscle or tracheal wall remains. A temporary silicone rubber intraluminal stent is placed and absorbable sutures secure the homograft. Regular postoperative bronchoscopic treatment clears granulation tissue. The stent is removed endoscopically after epithelialization over the homograft. Twenty-four children with severe tracheal stenosis (age 5 months to 18 years, mean +/- standard error of the mean = 8.18 +/- 1.21 years) underwent tracheal homograft reconstruction. All but one had had previous unsuccessful reconstructive attempts. Ten lesions were congenital, nine were posttraumatic, and five were due to prolonged intubation.
Follow-up ranged from 5 months to 10 years (3.79 +/- 0.70 years). Twenty patients survive (20/24 = 83%), 16 without any airway problems. Four patients are still undergoing treatment. One patient requiring emergency extracorporeal membrane oxygenator support before the operation died 10 days after tracheal homograft reconstruction. Another patient with severe preoperative mediastinal sepsis died 3.5 months after tracheal homograft reconstruction. Two patients with functional airways died late of unrelated problems.
Tracheal homograft reconstruction demonstrates encouraging short-term to medium-term results for children with severe recurrent tracheal stenosis. Postoperative bronchoscopic and histologic studies provide evidence of epithelialization and support the expectation of good long-term results.
气管狭窄在儿童中可能是一个危及生命的问题。长段气管狭窄和复发性气管狭窄尤其棘手。气管同种异体移植重建为这些患者提供了一种新的治疗方式。
获取尸体气管，用福尔马林固定，在硫柳汞（硫柳汞）中冲洗，并保存在丙酮中。将狭窄的气管段向近端和远端打开至广泛通畅的节段。切除前部软骨，保留后部气管肌或气管壁。放置一个临时硅胶腔内支架，并用可吸收缝线固定同种异体移植物。术后定期进行支气管镜治疗以清除肉芽组织。在同种异体移植物上皮化后通过内镜取出支架。24例严重气管狭窄患儿（年龄5个月至18岁，平均±平均标准误差=8.18±1.21岁）接受了气管同种异体移植重建。除1例患者外，其余患者之前的重建尝试均未成功。10例病变为先天性，9例为创伤后，5例为长期插管所致。
随访时间为5个月至10年（3.79±0.70年）。20例患者存活（20/24 = 83%），16例无任何气道问题。4例患者仍在接受治疗。1例在手术前需要紧急体外膜肺氧合支持的患者在气管同种异体移植重建后10天死亡。另1例术前严重纵隔感染的患者在气管同种异体移植重建后3.5个月死亡。2例有功能性气道的患者因无关问题晚期死亡。
气管同种异体移植重建对于患有严重复发性气管狭窄的儿童显示出令人鼓舞的短期至中期结果。术后支气管镜检查和组织学研究提供了上皮化的证据，并支持了良好长期结果的预期。
