先天性心脏病合并气管狭窄气管支架置入后取出指征探讨

目的 总结先天性心脏病（CHD）合并气管狭窄气管支架置入后取出指征.方法 比较分析CHD合并气管狭窄气管支架置入后尚留和取出病例的临床资料.结果 9例置入气管支架患儿均为重度气道狭窄,置入气管支架为乐普（北京）公司生产的血管金属支架（PARTNER）,其中尚留气管支架的4例患儿,平均年龄13.75个月,平均体重8.70 kg,随访支气管镜检查均未发现肉芽组织增生,镜下气管支架支撑良好;5例患儿于气管支架置入68～96 d 后取出,平均年龄4.8个月,平均体重4.96 kg.气管支架取出后发现支架支撑处并未塌陷,不影响患儿通气功能,取出气管支架完整,随访10～11个月,气道未见再阻塞及其他并发症,未出现需要再次置入气管支架的情况和死亡病例.在复习文献的基础上提出气管支架取出指征：①在良好的随访体系下气管支架置入2～3个月;②经支气管镜证实无肉芽组织增生,CT及其三维气道重建显示气道通畅;③临床无呼吸困难表现及感染征象,血气分析示无肺通、换气功能异常,X线胸片正常,超声心动图检查示心脏功能正常;④支气管镜下能清楚显示气管支架边界,且整个张开的支架位于气道表面并未上皮化;⑤支气管镜下钳夹住气管支架后,轻轻上下小幅推拉,镜下证实可以松动与气道紧密粘贴的支架.结论 对于小婴儿气管支架取出从长远角度来看是最佳选择,在良好的随访体系下,在不影响患儿生命质量的前提下,CHD合并气管狭窄气管支架置入2～3个月后取出安全可行.

Study on the removal indication for children with congential heart disease combined with bronchial stenosis after tracheal stenting

Objective To summarize the removal indications for children with congenital heart disease （CHD） combined with bronchial stenosis after tracheal stenting. Methods Clinical data of CHD children with bronchial stenosis whose tracheal stenting was still remained or removed were compared and analyzed. Results Nine cases of stenting patients were severe airway obstruction. Four children were alive and well with stents remained, with an average age of 13.75 months and average weight of 8.70 kg. During follow-up bronchoscopy in those patients, the stents had become almost fully covered by respiratory mucosa, without any evidence of granulation. Stents were placed for 68 to 96 days and were removed in 5 patients, with an average age of 4. 8 months and average weight of 4.96 kg. The removed stents had good shape without collapse. It didnt affect ventilatory function in children and there were no complications related to stent insertion, no more airway restenosis, no additional stent insertion and no death occurrence. On the basis of the literature review, the indications of stent removal were made ： （1） Stent has been placed for 2 to 3 months under the control of good follow-up system. （2） The airway was unobstructed and confirmed by bronchoscopy, CT and its three-dimensional airway reconstruction to be without any granulation tissue. （3） There was no sign of dyspnea or infection. Blood gas analysis showed no lung through ventilation dysfunction with normal X-ray and echocardiography examination. （4） Tracheal stent border could be clearly seen under bronchoscopy and no epithelialization was growing in the entire open bracket in the airway surface. （5） The stents could be pasted pushing and pulling gently up and down a slight under the bronchoscopy. Conclusions The removal of metallic stents ＇placed for 2 to 3 months is safe under the control of good follow-up system and with no adverse impact on the quality of life in children. It is the best choice for small babies to remove tracheal stent from a long-term perspective.