肺动脉吊带合并气管狭窄的外科治疗

发布时间：2019-04-16 12:03

【摘要】：目的探讨肺动脉吊带合并气管狭窄的诊断及治疗方法。方法选取2012年1月至2016年1月收治的肺动脉吊带合并气管狭窄患儿23例,依据气管狭窄程度分为轻度狭窄组(n=13)和重度狭窄组(n=10)。回顾性分析患儿临床特征、手术方式的选择及治疗效果。结果轻度狭窄组9例术前无明显呼吸道症状,重度狭窄组均有症状。轻度狭窄组仅行左肺动脉移植。重度狭窄组中完全型气管环、静息下喘鸣患儿行左肺动脉移植及气管重建术,其他患儿均不处理气管。重度狭窄组1例气管软化术中置入气管支架。轻度狭窄组患儿术后恢复顺利。重度狭窄组1例早期完全型气管环合并气管软化术中未处理气管,术后脱机困难,死于多脏器功能衰竭。3例同时行气管重建恢复顺利。放支架患儿术后气管内分泌物较多,需反复纤支镜吸痰,1个月后突然死于气道大出血。2例脱呼吸机后吸气困难严重,需无创机械通气支持。术后随访5~53个月,轻度狭窄组均无明显呼吸道症状,重度狭窄组生存患儿活动后仍有气喘2例。呼吸道症状在术后5~11个月缓解。结论肺动脉吊带合并气管狭窄临床表现无特异性,提高警觉性可以避免误诊。术前气管镜检查有助于准确评估气管狭窄的部位、类型及程度。气管狭窄的程度、类型及术前呼吸道的症状,是指导手术方式选择的重要依据。
[Abstract]:Objective to investigate the diagnosis and treatment of pulmonary artery sling combined with trachea stenosis. Methods from January 2012 to January 2016, 23 children with pulmonary artery sling complicated with trachea stenosis were divided into mild stenosis group (n = 13) and severe stenosis group (n = 10). The clinical features, the choice of surgical methods and the therapeutic effect were analyzed retrospectively. Results in the mild stenosis group, 9 cases had no obvious respiratory symptoms before operation, and all had symptoms in the severe stenosis group. Only left pulmonary artery transplantation was performed in mild stenosis group. In the severe stenosis group, the left pulmonary artery transplantation and trachea reconstruction were performed in the patients with complete trachea ring, resting wheezing, and none of the other children were treated with trachea. In the severe stenosis group, tracheal stents were implanted during tracheostomy in 1 case. The children in the mild stenosis group recovered smoothly after operation. In the severe stenosis group, the trachea was not treated in the early stage of complete trachea annuloplasty combined with trachea softening, the weaning was difficult after operation, and died of multiple organ failure, and 3 cases recovered smoothly after trachea reconstruction at the same time. After stenting, there were more trachea secretions, which needed to be sucked repeatedly by fiberoptic bronchoscope, and died of massive airway hemorrhage 1 month later. 2 cases had severe inspiratory difficulty and needed non-invasive mechanical ventilation support. After 5 months of follow-up for 53 months, there were no obvious respiratory symptoms in the mild stenosis group and 2 cases of asthma in the severe stenosis group. Respiratory symptoms were relieved 5 months after operation. Conclusion there is no specificity in the clinical manifestation of pulmonary artery sling with trachea stenosis, and the misdiagnosis can be avoided by raising the alertness. Preoperative tracheoscopy helps to accurately assess the location, type and extent of trachea stenosis. The degree and type of trachea stenosis and the symptoms of respiratory tract before operation are the important basis to guide the choice of surgical methods.
【作者单位】：山东大学齐鲁儿童医院心外科;
【分类号】：R726.5

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