滑片吻合术治疗长段先天性气管狭窄不良手术结果的危险因素分析  

Analysis of risk factors for adverse surgical outcomes of slide tracheoplasty for long-segment congenital tracheal stenosis

作　　者：温皖豫 杜欣为[1] 王浩[1] 王顺民[1] 徐志伟[1] 陆兆辉[1] Wen Wanyu;Du Xinwei;Wang Hao;Wang Shunmin;Xu Zhiwei;Lu Zhaohui(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,National Children's Medical Center,Shanghai 200127,China)

机构地区：[1]国家儿童医学中心,上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中华小儿外科杂志》2023年第4期295-301,共7页Chinese Journal of Pediatric Surgery

基　　金：浦东新区科技发展基金(PKJ2020-Y02)。

摘　　要：目的:通过随访结果评价长段先天性气管狭窄滑片吻合术手术效果并分析不良手术结果的危险因素。方法:回顾性分析2010年1月至2020年12月于上海儿童医学中心接受滑片吻合术治疗的长段先天性气管狭窄216例患儿的临床资料,其中男127例,女89例。将所有患儿的气管支气管分支分为4种不同的类型,Ⅰ型(100例):正常支气管分支;Ⅱ型(58例):隆突上方右上叶支气管的异常起源,表现为右上支气管直接开口于气管隆突上方右侧壁;Ⅲ型(44例):三叉形支气管分支;Ⅳ型(14例):单侧肺发育不良或者缺失。独立样本的t检验用于服从正态分布的连续变量的差异性检验,Mann-Whitney U检验用于非正态分布的变量的差异性检验。分类变量采用卡方检验或Fisher精确检验。应用logistic回归分析确定不良手术结果的危险因素。结果:中位随访时间为3.3年,范围在6个月至11年;术后院内死亡10例,晚期死亡2例。Ⅳ型术后肉芽增生发生率(14.3%,2/14)和延长机械通气发生率(35.7%,5/14)较高。多变量回归分析表明:狭窄段直径较小(P=0.004)、术前低体重(P=0.015)和术前隆突压迫(P=0.045)分别是术后气管软化的独立危险因素;全长狭窄是术后延长机械通气的独立危险因素(P=0.026);术前机械通气史和术中重建气管悬吊和总体死亡相关,其中有术前机械通气史是总体死亡的独立危险因素(P=0.019),气管悬吊术是总体死亡的保护因素(P=0.045)。结论:长段气管狭窄滑片吻合术后中期随访结果令人满意。狭窄段直径较小、术前低体重、术前隆突压迫、全长狭窄以及术前机械通气是不良手术结果的危险因素。气管悬吊术可以有效减少滑片吻合术后总体死亡率。Objective To evaluate the surgical efficacy of slide tracheoplasty for long-segment congenital tracheal stenosis through follow-ups and to determine the risk factors for adverse surgical outcomes.Methods From January 2010 to December 2020,clinical data were retrospectively reviewed for 216 children with long segment congenital tracheal stenosis undergoing slide tracheoplasty.There were 127 boys and 89 girls.According to the Speggiorin classification scheme,they were divided into typeⅠ(tracheobronchial branches),typeⅡ(normal bronchial arborisation),typeⅢ(anomalous origin of right upper lobe bronchus above carina)and typeⅣ(unilateral lung agenesis or absence).Independent-sample t test was utilized for examining the difference of continuous variables in a normal distribution and Mann-Whitney U test for variables in a non-normal distribution.Simultaneously,categorical variables were compared by Chi-square analysis or Fisher's exact test.Logistic regression analysis was employed for determining the risk factors of adverse surgical outcomes.Results During a median follow-up period of 3.3(6-11)years,the incidence of granulation hyperplasia(14.3%)and prolonged mechanical ventilation(35.7%)was higher after typeⅣsurgery.Multivariate regression analysis showed that smaller stenotic segment diameter(P=0.004),preoperative low body weight(P=0.015)and preoperative carina compression(P=0.045)were independent risk factors for postoperative tracheomalacia.Full-length stenosis was an independent risk factor of prolonged mechanical ventilation(P=0.026).Preoperative mechanical ventilation history and tracheopexy were relative to overall mortality,preoperative mechanical ventilation was an independent risk factor for overall mortality(P=0.019)and tracheopexy was a protective factor(P=0.045).Conclusions Intermediate-term follow-up outcomes are satisfactory for long-segment congenital tracheal stenosis after slide tracheoplasty.Smaller stenotic segment diameter,preoperative low body weight,preoperative carina compression,full-

关 键 词：气管狭窄 气管支气管软化 术后随访 

分 类 号：R726.5[医药卫生—儿科]