發(fā)布時間：2019-04-16 12:03

【摘要】：目的探討肺動脈吊帶合并氣管狹窄的診斷及治療方法。方法選取2012年1月至2016年1月收治的肺動脈吊帶合并氣管狹窄患兒23例,依據(jù)氣管狹窄程度分為輕度狹窄組(n=13)和重度狹窄組(n=10)�；仡櫺苑治龌純号R床特征、手術(shù)方式的選擇及治療效果。結(jié)果輕度狹窄組9例術(shù)前無明顯呼吸道癥狀,重度狹窄組均有癥狀。輕度狹窄組僅行左肺動脈移植。重度狹窄組中完全型氣管環(huán)、靜息下喘鳴患兒行左肺動脈移植及氣管重建術(shù),其他患兒均不處理氣管。重度狹窄組1例氣管軟化術(shù)中置入氣管支架。輕度狹窄組患兒術(shù)后恢復(fù)順利。重度狹窄組1例早期完全型氣管環(huán)合并氣管軟化術(shù)中未處理氣管,術(shù)后脫機(jī)困難,死于多臟器功能衰竭。3例同時行氣管重建恢復(fù)順利。放支架患兒術(shù)后氣管內(nèi)分泌物較多,需反復(fù)纖支鏡吸痰,1個月后突然死于氣道大出血。2例脫呼吸機(jī)后吸氣困難嚴(yán)重,需無創(chuàng)機(jī)械通氣支持。術(shù)后隨訪5~53個月,輕度狹窄組均無明顯呼吸道癥狀,重度狹窄組生存患兒活動后仍有氣喘2例。呼吸道癥狀在術(shù)后5~11個月緩解。結(jié)論肺動脈吊帶合并氣管狹窄臨床表現(xiàn)無特異性,提高警覺性可以避免誤診。術(shù)前氣管鏡檢查有助于準(zhǔn)確評估氣管狹窄的部位、類型及程度。氣管狹窄的程度、類型及術(shù)前呼吸道的癥狀,是指導(dǎo)手術(shù)方式選擇的重要依據(jù)。
[Abstract]:Objective to investigate the diagnosis and treatment of pulmonary artery sling combined with trachea stenosis. Methods from January 2012 to January 2016, 23 children with pulmonary artery sling complicated with trachea stenosis were divided into mild stenosis group (n = 13) and severe stenosis group (n = 10). The clinical features, the choice of surgical methods and the therapeutic effect were analyzed retrospectively. Results in the mild stenosis group, 9 cases had no obvious respiratory symptoms before operation, and all had symptoms in the severe stenosis group. Only left pulmonary artery transplantation was performed in mild stenosis group. In the severe stenosis group, the left pulmonary artery transplantation and trachea reconstruction were performed in the patients with complete trachea ring, resting wheezing, and none of the other children were treated with trachea. In the severe stenosis group, tracheal stents were implanted during tracheostomy in 1 case. The children in the mild stenosis group recovered smoothly after operation. In the severe stenosis group, the trachea was not treated in the early stage of complete trachea annuloplasty combined with trachea softening, the weaning was difficult after operation, and died of multiple organ failure, and 3 cases recovered smoothly after trachea reconstruction at the same time. After stenting, there were more trachea secretions, which needed to be sucked repeatedly by fiberoptic bronchoscope, and died of massive airway hemorrhage 1 month later. 2 cases had severe inspiratory difficulty and needed non-invasive mechanical ventilation support. After 5 months of follow-up for 53 months, there were no obvious respiratory symptoms in the mild stenosis group and 2 cases of asthma in the severe stenosis group. Respiratory symptoms were relieved 5 months after operation. Conclusion there is no specificity in the clinical manifestation of pulmonary artery sling with trachea stenosis, and the misdiagnosis can be avoided by raising the alertness. Preoperative tracheoscopy helps to accurately assess the location, type and extent of trachea stenosis. The degree and type of trachea stenosis and the symptoms of respiratory tract before operation are the important basis to guide the choice of surgical methods.
【作者單位】： 山東大學(xué)齊魯兒童醫(yī)院心外科;
【分類號】：R726.5

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