手术治疗肺动脉吊带合并气管狭窄15例的疗效分析  

Surgical treatment of pulmonary artery sling with tracheal stenosis in children: a report of 15 cases

作　　者：周文武[1] 伍明[1] 张志功[1] 陈飞 周亚夫[1] 陈仁伟[2] 刘平波[2] 

机构地区：[1]湖南省人民医院心胸外科,湖南省长沙市410005 [2]湖南省儿童医院心胸外科,湖南省长沙市410007

出　　处：《临床小儿外科杂志》2017年第6期583-587,共5页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨先天性肺动脉吊带合并气管狭窄的手术治疗经验及体会。方法 2010年7月至2016年10月,共计手术治疗儿童先天性肺动脉吊带15例,回顾性分析其手术治疗方法及预后。结果患儿手术时平均年龄1岁3个月,均体外循环下行异位左肺动脉移植术,气管据术中狭窄程度做不同处理:未处理6例、滑动成形5例、狭窄段切除端端吻合2例、气管纵行切开及心包补片增宽2例;手术死亡2例,死亡率为13.3%:其中滑动成形死亡1例、气管心包补片增宽死亡1例。结论婴幼儿先天性肺动脉吊带极易合并气管狭窄,气管狭窄手术修复较为困难,部分患儿单纯左肺动脉移植可带来满意疗效,重度长段气管狭窄需行气管滑动成形手术。Objective To summarize the clinical experiences of surgical management of pulmonary artery sling （PAS） with tracheal stenosis in children. Methods From July 2010 to October 2016, 16 PAS chil- dren with tracheal stenosis underwent corrective operations. And clinical data of operative techniques and surgical outcomes were reviewed retrospectively. Results The mean operative age was 15 months. All children un- derwent left pulmonary re-implantation with cardiopulmonary bypass and 6 had no further tracheoplasty. And 3 different techniques of tracheoplasty were used, including slide tracheoplasty （ n = 5 ）, tracheal resection ＆ end-to-end anastomose （ n = 2） and autologous pericardium patch enlargement （ n = 2 ）. The operative mortality was 13.3% （2/15）. One dies after autologous pericardium patch enlargement and another due to slide tracheoplasty. Conclusion Surgical management is challenging for PAS with tracheal stenosis. The surgical out- comes for left pulmonary re-implantation alone are acceptable in children with mild or moderate tracheal steno- sis. However, slide tracheoplasty is required for some cases with severe long-segment tracheal stenosis.

关 键 词：肺动脉吊带 气管狭窄 外科手术 

分 类 号：R726.5[医药卫生—儿科]