肺动脉吊带合并气管狭窄的外科治疗

doi:10.6040/j.issn.1671-7554.0.2016.969

摘要/Abstract

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。

关键词: 治疗结果, 外科学, 气管, 诊断, 心血管畸形

Abstract: Objective To explore the diagnosis and surgical treatment of pulmonary artery(PA)sling complicated with tracheal stenosis. Methods Clinical data of 23 cases of PA sling complicated with tracheal stenosis treated in our hospital during Jan. 2012 and Jan. 2016 were retrospectively analyzed. The patients were divided into mild stenosis group(n=13, MS group)and severe stenosis group(n=13, SS group)according to the extent of tracheal stenosis. The clinical features, surgical techniques and the treatment outcomes were reviewed. Results Altogether 9 patients(69%)in MS group had no obvious respiratory symptoms while all patients in SS group had obvious symptoms. Patients in MS group received left pulmonary artery(LPA)re-implantation alone. In SS group, patients with complete tracheal cartilage ring who had with stridor at rest underwent LPA re-implantation together with resection of narrowed segment and direct reanastomosis, 1 patient with tracheomalacia had tracheal stent placed, and the other patients received LPA re-implantation alone. All patients in MS group recovered smoothly. In SS group, 1 patient with complete tracheal ring and tracheomalacia who received LPA re-implantation without tracheal intervention failed to extubate after surgery and finally died of multiple organ failure; 3 patients who received LPA re-implantation and tracheoplasty simultaneously had an uneventful postoperative course, the patient with tracheal stent had excessive secretions in respiratory tract, received bronchoscopy repeatedly to clear sputum, and died 1 month later because of fatal bleeding from a tracheal stent suddenly; 2 patients required non-invasive continuous positive airway pressure(CPAP)to relieve respiratory distress after 山东大学学报 (医学版)55卷8期 -冯致余,等.肺动脉吊带合并气管狭窄的外科治疗 \=-extubation. During the follow-up of 5 to 53 months, all patients in MS group were free of respiratory symptoms; 2 patients in SS group showed tachypnea during exercise; the respiratory symptoms were relieved during 5 to 11 months after surgery. Conclusion PA Sling complicated with tracheal stenosis has no specific symptoms and care should be taken to avoid misdiagnosis. Preoperative fiber optic bronchoscopy intervention contributes to evaluate the location, type and degree of lumen stenosis exactly. Moreover, selection of surgical approach depends on the severity and type of stenosis in tracheal lumen and preoperative respiratory symptoms.

Key words: Cardiovascular abnormalities, Trachea, Treatment outcome, Surgery, Diagnosis

中图分类号:

R654

冯致余,杨彦亮,郭锐,徐惠惠,张健,郭凯,王广震,王辉. 肺动脉吊带合并气管狭窄的外科治疗[J]. 山东大学学报（医学版）, 2017, 55(8): 48-51.

FENG Zhiyu, YANG Yanliang, GUO Rui, XU Huihui, ZHANG Jian, GUO Kai, WANG Guangzhen, WANG Hui. Diagnosis and surgical treatment of pulmonary artery sling complicated with tracheal stenosis[J]. JOURNAL OF SHANDONG UNIVERSITY (HEALTH SCIENCES), 2017, 55(8): 48-51.

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