Kamata S, Usui N, Ishikawa S, Kitayama Y, Sawai T, Okuyama H, Fukui Y, Okada A
Department of Pediatric Surgery, Osaka University Medical School, Japan.
J Pediatr Surg. 1997 Jan;32(1):54-7. doi: 10.1016/s0022-3468(97)90093-2.
Although successful surgical management of congenital tracheal stenosis has been reported, it is still controversial as to the best operative procedure. Eleven infants with congenital tracheal stenosis were evaluated to confirm the efficacy of tracheobronchial reconstruction with costal cartilage graft. Symptoms ranged from recurrent respiratory infection to severe respiratory failure. All infants had other congenital anomalies in addition to tracheal stenosis. Notably, five infants had pulmonary artery sling and four infants had patent ductus arteriosus. Definitive diagnosis was made by bronchoscopy, results of which showed complete tracheal rings in all patients with severely compromised tracheobronchial lumens. Five infants had elongated stenosis involving nearly the whole length of the trachea, and five infants had segmental stenosis involving nearly one half the length of the trachea. One infant had bilateral stenosis of the main bronchi. Early experience included two deaths from problems related to the repair. The involvement of the carina and the distal portion of the trachea was associated with increased complications and a higher mortality rate. Currently, our preferred technique facilitated by extracorporeal membrane oxygenation (ECMO) includes carinal reconstruction with a thin-wall intraluminal stent. Bronchoscopy is essential for accurate intraoperative incision of the trachea, post-operative airway management for several weeks, and removal of the intraluminal stent.
尽管已有先天性气管狭窄手术治疗成功的报道，但对于最佳手术方式仍存在争议。对11例先天性气管狭窄婴儿进行评估，以证实肋软骨移植气管支气管重建的疗效。症状从反复呼吸道感染到严重呼吸衰竭不等。所有婴儿除气管狭窄外还患有其他先天性异常。值得注意的是，5例婴儿有肺动脉吊带，4例婴儿有动脉导管未闭。通过支气管镜检查做出明确诊断，结果显示所有气管支气管腔严重受损的患者均有完整的气管环。5例婴儿有累及几乎整个气管长度的长段狭窄，5例婴儿有累及气管近一半长度的节段性狭窄。1例婴儿有主支气管双侧狭窄。早期经验包括2例因修复相关问题死亡。隆突和气管远端受累与并发症增加和死亡率升高相关。目前，我们在体外膜肺氧合（ECMO）辅助下的首选技术包括用薄壁腔内支架进行隆突重建。支气管镜检查对于术中准确切开气管、术后数周的气道管理以及取出腔内支架至关重要。
