目的 探讨肺动脉吊带合并气管狭窄的治疗方法。 方法 分析2017年2月至2022年10月山东大学附属儿童医院收治的26例肺动脉吊带矫治术后因气管狭窄接受二次手术治疗的患儿资料。其中男14例，女12例；中位年龄为31.3个月；中位体重为13.7 kg；两次手术间隔中位时间为12.5个月。1级狭窄3例，2级狭窄15例，3级狭窄8例。合并右位心3例，合并左肺动脉狭窄或闭锁3例，合并迷走左锁骨下动脉畸形及Kommerell憩室1例。患儿均采用Slide气管成形术加宽气道。术后定期复查电子支气管镜。非正态分布数据采用Wilcoxon符号秩检验（配对样本）。 结果 26例患儿气管狭窄段长度中位数为4 cm，范围为2.5~6.6 cm。本研究病例无手术死亡，无住院期间死亡。术后呼吸机辅助中位通气时间为19.1 h。术后并发症包括吻合口漏合并胸骨哆开1例，声带麻痹3例，气管软化1例，乳糜胸1例，脑损伤2例。术后中位随访时间为7.0个月。活动耐力略差3例，其余患儿无呼吸道症状。3例行左肺动脉加宽术的患儿术后定期复查心脏彩色多普勒超声检查提示左肺动脉血流通畅。3例声带麻痹患儿术后3个月症状消失，2例脑损伤患儿均康复治疗中。 结论 当肺动脉吊带合并气管狭窄，气管最窄处宽度小于正常宽度的40%，或为正常宽度的40%~60%且临床症状明显时，应一期手术加宽气管。 Objective To explore the treatment of pulmonary artery sling (PAS) plus tracheal stenosis (TS). Methods From February 2017 to October 2022, the relevant clinical data were reviewed for 26 children undergoing secondary surgery for tracheal stenosis after pulmonary artery sling correction. There were 14 boys and 12 girls with a median age of 31.3 months and a median weight of 13.7 kg. The median interval between two surgeries was 12.5 months. Clinical grades of stenosis were Ⅰ (n=3), Ⅱ (n=15) and Ⅲ (n=8). Concurrent conditions included right-sided heart (n=3) and left pulmonary artery stenosis/occlusion (n=3). One child had combined left subclavian artery malformation and Kommerell diverticulum with vagus. Slide tracheoplasty was employed for widening airway. Regular postoperative reviews were conducted by electronic bronchoscopy. Wilcoxon's signed rank test (paired sample) was performed for abnormal distribution data. Results Median length of tracheal stenosis segment was 4(2.5-6.6) cm. There was no intraoperative or in-hospital mortality. Median period for postoperative ventilator assisted ventilation was 19.1 hours. Postoperative complications included anastomotic leakage plus sternal opening (n=1), vocal cord paralysis (n=3), tracheal softening (n=1), chylothorax (n=1) and brain injury (n=2). Median postoperative follow-up period was 7.0 months. Three cases had slightly poor activity endurance while the remainders were free of respiratory symptoms. Three cases of left pulmonary artery widening underwent regular echocardiographic follow-ups. There was unobstructed blood flow of left pulmonary artery. Three children of vocal cord paralysis resolved at 3 months postoperatively while two cases of brain injury underwent rehabilitation. Conclusions When pulmonary artery sling co-exists with tracheal stenosis, the width of the narrowest part of trachea is less than 40% of normal width or between 40% and 60% of normal width and clinical symptoms are obvious, trachea should be widened with one-stage surgery.
Secondary surgery for tracheal stenosis after pulmonary artery sling correction
Objective To explore the treatment of pulmonary artery sling (PAS) plus tracheal stenosis (TS). Methods From February 2017 to October 2022, the relevant clinical data were reviewed for 26 children undergoing secondary surgery for tracheal stenosis after pulmonary artery sling correction. There were 14 boys and 12 girls with a median age of 31.3 months and a median weight of 13.7 kg. The median interval between two surgeries was 12.5 months. Clinical grades of stenosis were Ⅰ (n=3), Ⅱ (n=15) and Ⅲ (n=8). Concurrent conditions included right-sided heart (n=3) and left pulmonary artery stenosis/occlusion (n=3). One child had combined left subclavian artery malformation and Kommerell diverticulum with vagus. Slide tracheoplasty was employed for widening airway. Regular postoperative reviews were conducted by electronic bronchoscopy. Wilcoxon's signed rank test (paired sample) was performed for abnormal distribution data. Results Median length of tracheal stenosis segment was 4(2.5-6.6) cm. There was no intraoperative or in-hospital mortality. Median period for postoperative ventilator assisted ventilation was 19.1 hours. Postoperative complications included anastomotic leakage plus sternal opening (n=1), vocal cord paralysis (n=3), tracheal softening (n=1), chylothorax (n=1) and brain injury (n=2). Median postoperative follow-up period was 7.0 months. Three cases had slightly poor activity endurance while the remainders were free of respiratory symptoms. Three cases of left pulmonary artery widening underwent regular echocardiographic follow-ups. There was unobstructed blood flow of left pulmonary artery. Three children of vocal cord paralysis resolved at 3 months postoperatively while two cases of brain injury underwent rehabilitation. Conclusions When pulmonary artery sling co-exists with tracheal stenosis, the width of the narrowest part of trachea is less than 40% of normal width or between 40% and 60% of normal width and clinical symptoms are obvious, trachea should be widened with one-stage surgery.
Tracheal stenosisAberrant left pulmonary arterySurgical treatment
万方数据
