先天性心脏病围手术期气管狭窄的综合治疗

目的 通过分析先天性心脏病围手术期气管狭窄患儿的治疗及转归,探讨不同原因导致气管狭窄的治疗方法.方法 回顾性分析2012年1月至2015年10月收治的60例气管狭窄合并先天性心脏病患儿的临床资料.其中,男42例,女18例;年龄1～144个月,平均4个月;体重(6.65±3.40) kg.先天性心脏病合并先天性气管狭窄39例,继发性气管狭窄21例.结果 先天性气管狭窄合并先天性心脏病39例,实施先天性心脏病矫治+气管狭窄旷置28例,先天性心脏病矫治+气管成形术5例,先天性心脏病矫治+气管支架置入1例;术后远期死亡共计4例,放弃手术治疗死亡4例,放弃治疗门诊随诊1例.继发性气管狭窄21例,实施心脏畸形矫治后气管软化狭窄减轻,不需手术治疗.结论 先天性心脏病合并先天性气管狭窄的主要致病原因在于其完全性软骨环导致气管内径增速缓慢,气道梗阻严重,即使实施心脏手术也不能完全改善其气管狭窄症状,必要时需同时实施气道成形术.继发性气管狭窄的主要致病原因在于气管临近大血管的压迫,缓解血管环畸形后气管狭窄即刻缓解,疗效满意,无需实施气管成形术.

Comprehensive treatment of perioperative tracheal stenosis in patients with congenital heart disease

Objective To explore the treatment and prognosis of congenital heart disease (CHD) in children and analyze the experiences of managing different causes.Methods There were 42 boys and 18 girls with a mean age of 4 (1-144) months and a weight range of (6.65 ± 3.40) kg.CHD co-existed with congenital tracheal stenosis (n =39) and softening airway stenosis (n =21).Results Treatment of CHD was combined with tracheal stenosis exclusion (n =28),trachea plasty (n =5) and tracheal stenting (n =1).The outcomes were late postoperative mortality (n =4),mortality after abandoning surgery (n =4) and outpatient follow-up (n =1).All 21 CHD cases of softening airway stenosis required no surgery and became self-cured.Conclusions The major pathogenesis of congenital tracheal stenosis lies in slow growth of tracheal diameter and severe airway obstruction.Although cardiac surgery can not completely improve the symptoms of airway stenosis,tracheoplasty may be added in cases of softening airway stenosis resulting in compressing major blood vessels adjacent to trachea.