小儿先天性气管狭窄矫治术及术后处理  

Correcting and postoperative management of congenital tracheal stenosis in children

作　　者：安育林[1] 付松[1] 杨学勇[1] 刘宇航[1] 王辉[1] 周更须[1] 

机构地区：[1]北京军区总医院附属八一儿童医院小儿心脏外科,北京100700

出　　处：《中国医药导报》2011年第18期45-47,共3页China Medical Herald

摘　　要：目的:总结小儿先天性气管狭窄(CTS)矫治术以及术后管理体会。方法:2006年5月～2011年1月,我院收治小儿CTS 12例,男7例,女5例;年龄22 d～13岁,平均(5.0±2.1)岁;体重2.1～48.0 kg,平均体重(10.2±3.7)kg。按照Grundfast法分期,Ⅰ期CTS 1例,Ⅱ期4例,Ⅲ期5例,Ⅳ期2例。合并畸形包括肺动脉吊带6例,动脉导管未闭(PDA)5例,房间隔缺损(ASD)4例,室间隔缺损(VSD)6例,中度肺动脉狭窄(PS)1例,法洛四联症1例,肺动脉高压2例,右室双出口3例,双腔右心室3例,永存左上腔静脉2例。采用胸骨正中切口,体外循环辅助下先天性气管狭窄矫治,同期纠正合并其他畸形。结果:气管端端吻合术5例,Slide气管成形术3例,自体游离气管片移植术3例,心包补片移植术1例。手术死亡1例,死亡率为8.3%。术后主要并发症有低氧血症(7例)和低心排(6例)。术后采用改良超滤7例,延迟关胸4例,呼吸机辅助9例,体外膜肺5例,静脉应用正性肌力药物4例。术后6个月～2年随访中,除2例轻度支气管狭窄外,心肺功能均良好。结论:同期纠治小儿CTS和并发并畸形的手术效果良好。防治术后低氧血症和低心排是降低CTS术后病死率的关键,包括施行改良超滤、延迟关胸、体外膜肺和预防性静脉应用强心药物等措施。此外,加强基础护理、营养支持、预防感染也很重要。Objective： To summarize correcting and postoperative management experience of congenital tracheal stenosis（CTS） in children.Methods： From May 2006 to January 2011,12 cases of pediatric with CTS were treated in our hospital,7 males and 5 females,aged 22 days to 13 years,mean（5.0±2.1） years,weight of 2.1-48.0 kg,average weight（10.2±3.7） kg.According to Grundfast principle,periodⅠCTS was in 1 case;4 cases of period Ⅱ;5 cases of period Ⅲ;2 cases of period Ⅳ.Malformations,including 6 cases of pulmonary artery sling（PAS）,patent ductus arteriosus（PDA） 5 cases,atrial septal defect（ASD） 4 cases,ventricular septal defect（VSD） 6 cases,moderate pulmonary stenosis（PS） 1 case,1 case of tetralogy of fallot（TOF） disease,pulmonary hypertension（PH） in 2 cases,3 cases of double outlet right ventricle（DORV）,dual-chamber right ventricle（DCRV） in 3 cases,2 cases of persistent left superior vena cava（LSVC）.Using median sternotomy incision,assisted correction of CTS was corrected under cardiopulmonary bypass,and other malformations were repaired at same period.Results： Tracheal anastomosis was in 5 cases,slide tracheoplasty in 3 cases,free tracheal autologous graft surgery in 3 cases,and pericardial patch graft in 1 case.Operative death was in 1 case,and mortality rate was 8.3%.The main complications were hypoxemia（7 cases） and low cardiac output（6 cases）.After operation,ultrafiltration was in 7 cases,4 cases of delayed sternal closure,mechanical ventilation in 9 cases,5 cases of extracorporeal membrane oxygenation（ECMO）,intravenous inotropic drugs in 4 cases.In the 6 months to 2 years follow-up,mild bronchial stenosis was in 2 postoperative children,heart and lung function were good.Conclusion： Operative effects of one stage corecting CTS with malformations are good.Management of postoperative hypoxemia and low cardiac output is key to reducing mortality after corecting CTS,including modified ultrafiltration,delayed sternal closure,ECMO and preventive app

关 键 词：先天性气管狭窄 小儿 矫治 术后处理 

分 类 号：R725[医药卫生—儿科]