Erwin E A, Gerber M E, Cotton R T
Department of Pediatric Otolaryngology and Maxillofacial Surgery, Children's Hospital Medical Center, University of Cincinnati College of Medicine, OH 45229-3039, USA.
Int J Pediatr Otorhinolaryngol. 1997 Jun 20;40(2-3):155-62. doi: 10.1016/s0165-5876(97)00045-1.
Vascular compression of the airway is a significant cause of respiratory compromise in children. While the indications for surgical repair are sometimes life threatening, they can also be subtle. This retrospective study examines 45 surgical cases of tracheobronchial compromise secondary to vascular compression at a large children's hospital between July 1983 and February 1996. A total of 34 were diagnosed with innominate artery compression, ten with a double aortic arch and one with an anomalous right subclavian artery. The 45 patients, 25 male and 20 female, ranged in age from 12 days to 11 years at surgery (average 13 months). A total of 21 (47%) presented with proven or suspected episodes of cyanosis or apnea. All 45 patients had evidence of vascular compression during microlaryngoscopy and bronchoscopy. The diagnosis was confirmed by magnetic resonance imaging (MRI) in 23/45 (51%), barium swallow in 22/45 (49%) and aortogram in 3/45 (7%). There was one death. One patient had a tracheotomy before surgery and continues to require it after surgery. Complete resolution of symptoms was achieved in 39/45 (87%) with five requiring more than one operation before their symptoms resolved completely. A total of four patients experienced a recurrence of symptoms within a variable length of time after surgery. Surgical indications and treatment alternatives will be discussed.
气道血管受压是儿童呼吸功能不全的一个重要原因。虽然手术修复的指征有时会危及生命，但也可能很隐匿。这项回顾性研究调查了1983年7月至1996年2月间在一家大型儿童医院进行的45例因血管受压导致气管支气管功能不全的手术病例。其中34例诊断为无名动脉受压，10例为双主动脉弓，1例为右锁骨下动脉异常。45例患者中，男性25例，女性20例，手术时年龄从12天至11岁不等（平均13个月）。共有21例（47%）出现过经证实或疑似的发绀或呼吸暂停发作。所有45例患者在显微喉镜检查和支气管镜检查时均有血管受压的证据。通过磁共振成像（MRI）确诊23/45例（51%），吞咽钡剂检查确诊22/45例（49%），主动脉造影确诊3/45例（7%）。有1例死亡。1例患者在手术前进行了气管切开术，术后仍需气管切开。39/45例（87%）症状完全缓解，5例在症状完全缓解前需要进行不止一次手术。共有4例患者在术后不同时间出现症状复发。将讨论手术指征和治疗选择。
