婴幼儿先天性心脏病伴气管狭窄的一期矫治

目的回顾总结一期纠治婴幼儿先天性心脏病（先心病）伴气管狭窄的体会。方法2001年8月至2005年11月，6例先心病伴气管狭窄的婴幼儿行一期手术矫治。手术年龄24d～3岁；体重4．2～10．0kg，平均（7．98±2．03）kg。其中法洛四联症3例，1例伴肺动脉闭锁；室间隔缺损2例，1例伴主动脉缩窄；肺动脉吊带1例。所有病儿均在低温体外循环下行先心病纠治术，同时处理气管狭窄。结果术后早期1例左、右支气管均匀性狭窄，不能脱离呼吸机死亡。1例肺动脉吊带者术后顺利出院，3个月后出现气管内肉芽增生，家属放弃治疗。余4例术后恢复良好，随访6个月至4年，临床上无气促表现。超声复查心功能良好，其中3例经CT复查，显示气管吻合口通畅，无明显狭窄。结论先心病伴先天性气管狭窄，以一期手术治疗为好，不但术中在体外循环下纠治气管狭窄较安全，而且同时纠治先心病有利于手术后病儿康复。     

保守插管策略在先天性心脏病合并气管狭窄患儿术中的应用

正先天性心脏病(简称先心病)合并气管狭窄非常罕见~([1])。上海儿童医学中心报道,约0.15%先心病患儿合并气管狭窄~([2])。目前气管狭窄常采用Slide矫治术或端端吻合术,但患儿术后常发生瘢痕及肉芽生长。支气管镜下治疗患儿气管狭窄难度很大~([3]),先心病患儿常需在心肺转流(CPB)辅助下行开胸心脏畸形矫治术,手术过程中需行气管插管,保证气道通畅,但可能造成气管狭窄段的损伤,术后发生黏膜下     

先天性心脏病合并气道异常的围术期处理

目的提高对先天性心脏病合并气道异常的认识,总结围术期处理经验。方法对中南大学湘雅二医院2006年1月至2008年1月收治的5例先天性心脏病合并气道异常患者的临床资料进行回顾性分析,其中男3例,女2例;年龄5个月~9岁,平均年龄27个月。气道异常包括:左主支气管狭窄2例,右侧气管化支气管、气管轻度软化和左主支气管狭窄、长段先天性气管狭窄各1例。行先天性心脏病矫治术加左主支气管成形术1例,仅行先天性心脏病矫治术3例,放弃手术治疗1例。结果围术期死亡1例,为先天性心脏病合并右侧气管化支气管,术后发生右肺上叶不张、肺部感染和呼吸衰竭死亡。1例先天性心脏病合并左主支气管狭窄,同期行左主支气管成形术后顺利出院;随访2年健康。1例行先天性心脏病矫治术后撤离呼吸机困难,发现合并先天性左主支气管狭窄伴轻度气管软化,经内科处理撤离呼吸机后仍有喘憋;随访6个月患者发育好,喘憋未再发作。1例混合型室间隔缺损致心脏扩大、肺动脉扩张压迫左主支气管导致狭窄,行先天性心脏病矫治术后左主支气管压迫症状缓解;随访1年健康。1例合并长段气管狭窄,家属放弃手术。结论先天性心脏病合并气道异常临床上很少见。应提高对该病的认识,做到术前确诊;采用最佳的手术方法,尽量与先天性心脏病同期手术纠治;术后加强呼吸道管理,以获得最佳的疗效。     

先天性血管环的外科治疗

目的 讨论先天性血管环的诊断和手术治疗及影响预后的因素.方法 回顾性分析2010年1月至2013年12月收治的42例先天性血管环患儿(占同期手术患儿的1.04％)的病例资料.其中男性26例,女性16例;手术年龄24d至6岁,平均10.7个月.包括肺动脉吊带26例,双主动脉弓10例,右位主动脉弓合并迷走左锁骨下动脉3例,肺动脉吊带合并右位主动脉弓并迷走左锁骨下动脉2例,肺动脉吊带合并左位主动脉弓并迷走右锁骨下动脉1例.38例患儿合并其他的心血管畸形.36例患儿行螺旋CT检查气道重建,23例患儿行纤维支气管镜检查,除2例气道未见异常外其余患儿均存在不同部位不同程度的气管狭窄或软化.所有患儿均行手术矫治先天性血管环,根据情况同期行心内畸形矫治手术;1例同期行气管狭窄切除并Slide成形术,1例在术后行气管内支架植入术.结果 3例患儿院内死亡(7.1％),死亡原因均为术后反复发生气管内肉芽肿形成;其余39例均顺利出院.存活患儿总体术后呼吸机辅助时间14 h(22 h)[M(QR)],心脏ICU停留时间5d(8 d),住院时间19 d(9 d).肺动脉吊带患儿呼吸机辅助时间、心脏ICU术后停留时间均长于双主动脉弓患儿[23 h(123 h)比9 h(9 h),7 d(13 d)比4 d(2 d)],但差异无统计学意义(P＞0.05);住院时间明显长于双主动脉弓患儿[23 d(9 d)比16 d(6 d)],差异有统计学意义(x2=10.157,P=0.006).结论 先天性血管环早期手术治疗是安全、有效的,近期效果良好.合并的气管软化和狭窄的程度和范围是影响患儿预后的关键.     

先天性心脏病合并气管狭窄患儿的术后气道护理

目的探讨先天性心脏病合并气管狭窄患儿的术后气道护理策略。方法对26例先天性心脏病合并气管狭窄患儿行矫治心血管畸形术,同时2例行气管重建,1例放置气管支架,其余患儿未处理气管。术后加强有创通气护理、无创通气护理,保持患儿镇静,注重体位护理及气道管理。结果患儿术后行有创呼吸机辅助通气时间24~139(51.0±18.0)h。11例气管导管拔管后出现烦躁、吸气困难,给予开放气道、镇静及雾化吸入,其中8例患儿症状缓解,另3例需要CPAP辅助通气。1例术后死于多脏器功能衰竭。术后随访5~37(21.0±5.2)个月,1例术中放置气管支架患儿术后1个月突然死于气道大出血,生存患儿中3例仍有活动后气喘,其余患儿无明显呼吸道症状。结论对先天性心脏病合并气管狭窄患儿术后细致周密的气道护理,能够提高手术成功率、减少并发症,促进患儿早日康复。     

喉罩在先天性心脏病伴气管狭窄患儿麻醉中的应用

先天性心脏病(先心病)伴气管狭窄,以往在先心病矫治术时气管狭窄不做处理,有些患儿会为此发生术后脱机困难;如果气管狭窄行一期矫治手术(去除狭窄段断端吻合术或补片扩大管径术等),手术创伤大,死亡率高[1],本文采用喉罩全麻下先心病矫治术联合纤支镜介入技术,检查评估先心病矫治术后气管狭窄改善情况,对中、重度气管狭窄患儿行纤支镜下球囊扩张、气管支架置入术等治疗,取得了很好     

3D打印技术在先天性气管狭窄诊断与手术治疗中的应用

目的评估3D打印技术在先天性气管狭窄外科治疗中的应用价值。方法回顾性分析我院2013年2月至2014年5月在3D打印技术指导下4例婴幼儿先天性气管狭窄的术前诊断、术中决策及术后随访的临床资料。其中男3例、女1例,平均年龄(23.0±7.1)个月,合并肺动脉吊带2例、室间隔缺损1例、法洛四联症1例。术前气管狭窄均经胸部CT及3D打印气管模型诊断,结合开胸前麻醉下气管镜检查确诊。术中先在体外循环下完成心脏畸形纠治,而后在平行循环下完成气管手术。气管手术方案的设计和实施由3D打印气管模型提供的数据和形态指导。气管主干长段狭窄2例,行Slide吻合;气管桥型狭窄2例,1例合并右下支气管开口狭窄者行扩大的Slide吻合,1例直接行端端吻合。结果全组患儿术前3D打印气管模型与气管镜检查及术中探查结果相符,术中气管镜证实气管狭窄完全纠治,吻合口对合完整,管腔通畅,无手术死亡,无重大并发症。术后随访1~2年,呼吸平稳,3D模型显示气管通畅。结论 3D打印技术能为先天性气管狭窄术前诊断和手术方案的设计、术中决策和操作提供很好的指导,提高气管狭窄手术治疗的成功率。     

先天性气管狭窄合并非血管环类心脏畸形的治疗策略

目的探讨先天性气管狭窄合并非血管环类心脏畸形的手术治疗策略。方法本研究为回顾性病例系列研究。回顾性收集2017年2月至2023年3月于山东大学附属儿童医院心脏外科接受手术治疗气管狭窄的24例患儿资料。男16例, 女8例;年龄[M(IQR)]6.5(19.6)个月(范围:2.2～66.3个月), 体重5.95(4.76)kg(范围:3.2～20.0 kg)。全组病例均存在明显呼吸道症状。其中同期行心脏畸形矫治及气管成形术(同期组, 18例);因一期手术前漏诊、延迟诊断气管狭窄或不存在气管成形术条件, 一期手术仅行心脏畸形矫治, 二期手术行气管成形(分期组, 6例)。气管狭窄矫治均采用Slide气管成形术。随访患儿恢复情况。组间比较采用Wilcoxon符号秩检验。结果全部病例无手术死亡, 无住院期间死亡。同期组1例延迟关胸患儿于52 h后行床旁关胸手术, 2例术后再次行气管插管, 1例行气管内支架植入;呼吸机辅助通气时间40.5(39.6)h(范围:19.0～438.8 h)。分期组1例术后再次插管, 合并左侧声带麻痹、呼吸道多重耐药菌感染(鲍曼不动杆菌);1例支气管镜下球囊扩张右中间支气...     

先天性气管狭窄介入治疗后再狭窄的外科手术治疗9例临床分析

目的探讨对曾接受反复球囊扩张或金属支架置入的先天性气管严重狭窄患儿行手术治疗的经验。方法回顾性分析9例曾接受反复球囊扩张(>3次)或气管内置入金属支架治疗, 后因狭窄症状明显于2017年2月至2021年7月在山东大学齐鲁儿童医院心脏外科接受手术治疗的先天性气管狭窄患儿的临床资料。男7例, 女2例。中位手术年龄72.4个月(范围:13.3～98.9个月), 中位体重19.0 kg(范围:9.0～33.0 kg)。9例患儿均有完全性气管软骨环及长段狭窄。2例患儿分别在本次手术17.8、51.8个月前开始接受反复球囊扩张(均>3次);7例患儿曾接受金属支架置入, 距首次置入金属支架时间1例患儿为4 d, 另6例患儿中位时间为56.8个月(范围:21.6～74.2个月)。9例患儿均行Slide气管成形术。结果 Slide气管成形术均顺利完成。2例反复球囊扩张患儿, 术中见气管壁厚薄不一、局部瘢痕增生、管腔不规则, 其中1例气管壁局部明显钙化, 缝合难度较大。7例支架置入患儿, 1例因支架置入时间短, 完整取出支架, 其余6例因支架置入时间长仅能取出部分金属支架。本组患儿无手术死亡,...     

大动脉转换术在复杂先天性心脏病治疗中的应用

目的 回顾总结我院近3年采用大动脉转换术治疗小儿复杂先天性心脏病(先心病)的临床经验。方法2000年1月至2003年5月,采用大动脉转换术(Switch手术)治疗小儿复杂先心病61例。其中完全性大血管错位(TGA)45例,包括室间隔完整型(TFGA-IVS)26例,伴室间隔缺损(TGA,VSD)19例;右心室双出口伴肺动脉瓣下室间隔缺损(Taussig-Bing)16例。结果TGA,IVS死亡2例;TGA-VSD死亡4例;Taussig-Bing死亡4例;总手术病死率16％。术后随访3个月-3年,所有病例青紫症状消失,活动能力明显增强。1例Taussig-Bing术前二尖瓣轻～中度返流,术后仍为中度返流。2例TGA术后出现主动脉和肺动脉瓣上狭窄,压差40mmHg,1例肺动脉瓣下狭窄和残余室间隔缺损,3个月后再次手术治愈。结论大动脉转换术应用于完全性大血管错位的纠治,手术效果满意;应用于右室双出口肺动脉瓣下室间隔缺损的纠治,不但可早期纠治,防止其肺血管阻塞性病变发生,而且避免了心内修补左室流出道梗阻的远期并发症。     

One Stage Surgical Correction of Congenital Cardiac Disease and Congenital Tracheal Stenosis in Infants and Children

Abstract   Objective: We describe our experience with patients undergoing one stage surgical correction of congenital cardiac disease and congenital tracheal stenosis. Methods: Between February 2001 and June 2007, eight patients underwent one stage repair of congenital cardiac disease and congenital tracheal stenosis. Their ages ranged from 30 days to 3 years (mean 16.25 ± 11.67 months) and weights from 4.2 to 10.5 kg (mean 8.24 ± 2.16 kg). The congenital cardiac disease was treated during cardiopulmonary bypass, and the tracheal stenosis was corrected simultaneously. Results: There was no operative mortality. One 4-month-old female who underwent polytetrafluroethylene patch tracheoplasty developed granulation tissue and died 3 months postoperatively of bronchial obstruction. The medium-term result of the remaining seven patients, after a mean follow-up of 50.4 months (range 9 to 76 months), was a stabile and complication-free clinical outcome. Conclusion: We advocate one stage surgical correction of congenital cardiac disease and congenital tracheal stenosis for the treatment of these conditions.     

Management of congenital tracheal stenosis

Objectives: Congenital tracheal stenosis is a rare disease. Various methods for treatment exist but there is still much debate as to the appropriate surgical procedure. We present our surgical experiences of patch tracheoplasty and slide tracheoplasty as viable methods for the treatment of congenital tracheal stenosis. Methods: From 1994 to 2002, 13 patients were diagnosed with congenital tracheal stenosis. Eight patients (7 symptomatic and 1 asymptomatic) had their stenosis corrected, three by means of pericardial patch tracheoplasty, four by slide tracheoplasty, and one by resection and anastomosis. Concomitant operations were performed on six patients to treat congenital cardiovascular disease. Five patients showing no significant symptoms did not undergo tracheal surgery and received only cardiac procedures. A retrospective review of the hospital course, complications, and long-term results was conducted. Results: Among the patch tracheoplasty group, every patient suffered from granulation tissue formation. One patient died of respiratory acidosis and one was hospitalized due to recurrent granulation tissue, which required frequent bronchoscopy. The third patient from this group is free of all symptoms. Among the slide tracheoplasty group, one patient died of anastomosis disruption. The three remaining patients are alive and well. The one patient who received resection and anastomosis is alive without symptoms. Conclusions: Surgical repair of long-segment congenital tracheal stenosis exhibited high mortality and morbidity rates. Every patient that underwent pericardial patch tracheoplasty suffered from troublesome granulation tissue. As slide tracheoplasty provided relatively good results in the short and mid-term follow-up periods, it seems to be a preferred method for the treatment of long-segment congenital tracheal stenosis.     

Powered instrumentation in the treatment of tracheal granulation tissue for decannulation.

OBJECTIVE: To evaluate the outcomes of powered instrumentation tracheal surgery (PITS) in patients with tracheal granulation tissue following tracheostomy that caused or exacerbated airway obstruction and impeded decannulation. STUDY DESIGN: Retrospective case review. METHODS: Sixteen patients that accepted PITS for decannulation from tracheal granulation tissue were reviewed. The surgical procedure was performed with the assistance telescope connected to a television monitoring system. The success of PITS was defined as a decannulation for 3 months without a recurrence of airway obstruction. RESULTS: The average operation time was 34 minutes. No complication was met in the perioperative period. Fourteen cases (87.5%) were successfully decannulated within 3 days following PITS. The 2 cases that failed successful decannulation had undergone insertion of a tracheal stent for their hindered tracheal stenosis. CONCLUSIONS: The preliminary results reveal that the new operation modality, PITS, is a safe and simple method for the treatment of tracheal granulation tissue and could be a useful alternative for benign tracheal lesions.     

Use of a larynyngeal mask airway during aortic valve replacement

We report the elective use of a laryngeal mask airway during cardiac surgery for congenital tracheal stenosis. A 53-year-old woman with severe aortic valve stenosis was scheduled for aortic valve replacement. During anesthesia induction, the anesthesiologists attempted conventional intubation but failed. Fiberoptic tracheal examination and computed tomography showed a tracheal stenosis with 5 mm minimal diameter. A laryngeal mask airway was used at the patient's rescheduled surgery. The laryngeal mask airway use did not lead any surgical complication. We concluded that the laryngeal mask airway may be considered as an alternative to conventional intubation in patients with tracheal stenosis.     

Use of a larynyngeal mask airway during aortic valve replacement

We report the elective use of a laryngeal mask airway during cardiac surgery for congenital tracheal stenosis. A 53-year-old woman with severe aortic valve stenosis was scheduled for aortic valve replacement. During anesthesia induction, the anesthesiologists attempted conventional intubation but failed. Fiberoptic tracheal examination and computed tomography showed a tracheal stenosis with 5 mm minimal diameter. A laryngeal mask airway was used at the patient's rescheduled surgery. The laryngeal mask airway use did not lead any surgical complication. We concluded that the laryngeal mask airway may be considered as an alternative to conventional intubation in patients with tracheal stenosis.     

Tracheoplasty for long segment congenital tracheal stenosis: analysis of 29 patients over two decades

Purpose: The authors determined the long-term outcome of patients who underwent surgical repair of long-segment congenital tracheal stenosis (LCTS) and compared the quality of cartilage graft and slide tracheoplasty techniques.Methods: Twenty-nine patients underwent surgical repair of LCTS at 29 days to 9 years of age. In 26 patients, more than 50% of the entire length of the trachea was involved. The early 12 patients (1981 through 1992) were treated with a costal cartilage graft for tracheal reconstruction. The remaining 17 patients (1997 through 2002) were treated with slide tracheoplasty. For both procedures, a median sternotomy was preferred because of convenience when using extracorporeal circulation and for simultaneous repair of associated cardiovascular anomalies.Results: Of the 12 patients who underwent a costal cartilage graft, 8 survived (66%). Six of these patients are free of disease, but 2 have persistent airway problems. Three patients died of residual stenosis and 1 of unrelated disease. Of the 17 patients who underwent slide tracheoplasty, 13 survived (76%), and 10 are free of disease. Three patients continue to require a stent because of tracheomalacia and granulation. Two patients died of cardiac failure, 1 of granulation, and 1 of aspiration pneumonia.Conclusions: The authors challenged LCTS with a unique surgical approach and succeeded in making an incurable disease curable. When the cartilage graft technique is compared with slide tracheoplasty, however, the latter is preferable because it preserves native tracheal tissue with less frequent complications.     

手指扩肛和手术治疗术后肛门直肠狭窄72例效果观察

为总结术后肛门与直肠狭窄的治疗经验，回顾性分析采用手指扩肛和敞开式手术方式、不加缝合手术创面治疗各类肛肠病手术后造成肛门与直肠狭窄患者72例，其中肛裂术后引起肛门狭窄6例，各类肛瘘术后引起肛门直肠狭窄12例，外痔术后引起肛门狭窄12例，混合痔术后引起肛门直肠狭窄8例，PPH术后引起直肠环状狭窄16例，各类直肠术后引起直肠狭窄18例。结果显示：治愈46例，好转26例，总有效率100％。结果表明，门诊诊治，局部麻醉，手术简单，疗效确切。痛苦少，疗程短，且无后遗症和并发症，更容易被患者所接受。     

Utilization of the Edge-to-Edge Valve Plasty Technique to Correct Severe Tricuspid Regurgitation in Patients with Congenital Heart Disease

Abstract   Objective: Tricuspid regurgitation is often associated in patients with congenital heart disease. Significant morbidity and mortality are related to tricuspid valve replacement. Tricuspid valve plasty is still a preferred choice. This report deals with our surgical experience in using the edge-to-edge valve plasty technique to correct severe tricuspid regurgitation in patients with congenital heart disease. Methods: From December 2002 to August 2007, severe tricuspid regurgitation was corrected with a flexible band annuloplasty and edge-to-edge valve plasty technique in nine patients with congenital heart disease. The age ranged from 7 to 62 years (average 24.4 years). Congenital cardiac anomalies included atrioventricular canal in five cases, secundum atrial septal defect in three cases, and cor triatriatum in one case. Results: No hospital death or postoperative morbidity occurred. No or trivial tricuspid regurgitation was present in six cases and mild tricuspid regurgitation in three cases at discharge. The follow-up ranged from 12 months to 70 months (average 39.3 months). No tricuspid stenosis was found. No to mild tricuspid regurgitation was present in eight cases, and moderate tricuspid regurgitation in one case at the latest follow-up. Conclusions: Edge-to-edge valve plasty is an easy, effective, and acceptable additional procedure to correct severe tricuspid regurgitation in patients with congenital heart disease.     

Long segment congenital tracheal stenosis in twins successfully treated by slide tracheoplasty

Long segment congenital tracheal stenosis (LSCTS), associated with complete tracheal rings, is a rare condition, difficult to manage and historically associated with high mortality rate. We report two pairs of identical twins all affected by LSCTS successfully treated by sliding tracheoplasty. All had severe respiratory distress. Three infants had left pulmonary artery (LPA) sling and one intra-cardiac malformation. Slide tracheoplasty was done under cardiopulmonary bypass, and cardiovascular malformations were corrected at the same time. One child needed plication of paralyzed right hemi-diaphragm and another distal tracheal Palmaz stent insertion due severe tracheobronchomalacia. All children are doing well during 6 months follow-up. Slide tracheoplasty seems to produce the same good early results in twins as for singletons with LSCTS.     

Sliding tracheoplasty of complete tracheal cartilage rings in children

IntroductionComplete tracheal rings are a rare malformation that occurs in 1 out of 100,000 live births. It is rare, isolated tracheal or tracheobronchial anomaly developed due to abnormal cartilage growth with formation of complete ring and often resulting in airway stenosis. Slide tracheoplasty, as it was originally described by Tsang et al. and popularized by Grillo et al., overlaps stenotic segments of trachea, shortening trachea itself, thus, doubling the circumference and diameter of the stenotic area.Materials and methodsWe have performed slide tracheoplasty in 12 children during the period of 2019–2021 in thoracic surgery department of our center. Median age was 15 ± 21,1 months (2 months-6 years),median weight – 8,04 ± 4,75 kg (3–20,7 kg),tracheal lumen varied from 2.5 to 3.0 mm, stenosis length – from 40 to 70% of the trachea length.ResultsSlide tracheoplasty was performed using central veno-arterial extracorporeal membrane oxygenation in 7 cases and using cardiopulmonary bypass in 5 cases. Concomitant heart disease was revealed in 5 children (pulmonary artery sling in 3 cases, ventricular septal defects – 1, aberrant subclavian artery −1). 5 children underwent one-stage correction of VSD: plastic VSD –1; left pulmonary artery reimplantation – 3; subclavian artery reimplantation – 1. All patients were on mechanical ventilation for 4,3 ± 2,78 days at postoperative period. Patients were discharged 16,3 ± 5,14 days after surgery. Satisfactory result of treatment in the form of respiratory failure relief was achieved in 10 patients. It was possible to increase the trachea lumen from 1.5 to 2 times in all cases. There were 2 (16,6%) fatal cases due to sepsis and multi-organ failure development.ConclusionsChildren with complete tracheal rings are very complicated patients with various comorbidities. Despite the advances in medicine, sometimes it is impossible to save lives of these children. The use of extracorporeal circulation (ECMO and bypass) allows us to safely perform reconstructive surgery on the trachea and save the child from respiratory failure manifestations. If needed, simultaneous correction of heart and tracheal defects is possible. Slide tracheoplasty allows to increase trachea lumen at least in 1.5–2 times. Mechanical ventilation is an unfavorable predictive factor for the outcomes of congenital tracheal stenosis management.Level of evidenceIII.