婴幼儿先天性气管狭窄合并先天性心脏病一期手术纠治

目的总结婴幼儿先天性气管狭窄伴先心病一期纠治经验和效果。方法回顾性分析2012年我院收治的12例先天性气管狭窄合并先心病患儿的临床资料。患儿平均年龄15.75月,平均体重9.38 kg。所有病例均在浅低温或中低温体外循环下行先心病纠治术,同时行气管成形术。结果所有患儿手术均成功,其中10例采用Slide气管成形法,2例采用端端吻合法。术后并发症包括肺炎4例,气道分泌物增多5例,气道高反应4例,肉芽组织生长3例,其中2例最终呼吸衰竭死亡;其余患者术后恢复良好。结论小儿先天性气管狭窄的处理仍较困难,Slide手术方法是目前处理主气管狭窄的最佳手术方式,特别适合于长段和弥漫性气管狭窄的患者。但是,先天性气管狭窄患者的治疗仍需要以气管成形手术为中心的综合治疗。

Onestage Surgical Intervention of Congenital Tracheal Stenosis Combined Congenital Heart Disease in Infants and Children

Objective To assess the effect and experience on onestage surgical repair of congenital tra- cheal stenosis combined congenital heart disease. Methods The clinical data of 12 cases suffered congenital cardiac disease and congenital tracheal stenosis was analyzed retrospectively. Their average age was 15.75 months and the average weight was 9.38 kg. All cases were performed corrective surgery of congenital cardiac disease and traeheoplasty under mild hypothermic cardiopulmonary bypass or low temperature at the same time. Results The surgical operation was successfully accomplished in all 12 cases, including Slide method in 10 cases and the end to end anastomosis method in 2 cases. The postoperative complication was pneumonia in 4 ca- ses, increased airway secretions in 5 cases, airway hyper-reaction in 4 cases, and the growth of granulation tis- sue in 3 cases. Two cases died of respiratory failure associated with growth of granulation tissue. The other ca- ses were restored well. Conclusions Treatment of congenital tracheal stenosis is still difficult in infants and children. Slide method is currently the best surgical procedure for main tracheal stenosis, particularly suitable for long segment and diffuse tracheal stenosis. However, the patients with congenital tracheal stenosis still need comprehensive treatment with the center of tracheoplasty.