胸腔镜联合3D打印生物可降解气管外支架治疗复发性气管食管瘘  

Thoracoscopy plus 3D-printed bioresorbable airway external stent for complex recurrent tracheoesophageal fistula

作　　者：刘瑶[1] 余强[1] 郭询 吉祥 苗春林[1] 贺健康[3] 李鹏[1] Liu Yao;Yu Qiang;Guo Xun;Ji Xiang;Miao Chunlin;He Jiankang;Li Peng(Department of Pediatric Surgery,Second Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710004,China;Department of Thoracic Surgery,Second Affiliated Hospital,Xi'an Jiaotong University,Xi'an 710004,China;State Key Laboratory for Manufacturing System Engineering,Xi'an Jiaotong University,Xi'an 710054,China)

机构地区：[1]西安交通大学第二附属医院小儿外科,西安710004 [2]西安交通大学第二附属医院胸外科,西安710004 [3]西安交通大学机械制造系统工程国家重点实验室,西安710054

出　　处：《中华小儿外科杂志》2023年第11期980-985,共6页Chinese Journal of Pediatric Surgery

基　　金：陕西省自然科学研究计划项目 (2021JM-298)。

摘　　要：目的探讨胸腔镜联合个体化3D打印生物可降解气管外支架治疗复杂的复发性气管食管瘘的可行性和安全性。方法收集2022年1月至2022年8月在西安交通大学第二附属医院小儿外科治疗的7例复发性气管食管瘘(recurrent tracheoesophageal fistula,rTEF)患儿的临床资料,其中女2例,男5例,年龄在4个月至10岁。依据术前胸部薄层CT(0.5 mm)进行气道三维重建并设计个体化支气管外支架,于西安交通大学机械制造系统工程国家重点实验室3D打印制作。所有患儿均接受胸腔镜气管食管瘘修补术联合3D打印生物可降解气管外支架置入术,支架于瘘管水平包绕气管并固定于气管软骨。结果7例患儿均成功完成胸腔镜气管食管瘘修补术及个体化3D打印生物可降解气管外支架置入术。手术时间为120~200 min,术后机械通气时间为5~11 d,监护病房住院日6~13 d,总住院日14~37 d。2例术后出现吻合口瘘,经保守治疗后痊愈。随访10~15个月时,7名患儿均未见气管食管瘘复发。结论胸腔镜气管食管瘘修补术联合3D打印可降解气管外支架可阻止rTEF黏膜管道的再通,可预防rTEF的复发,安全可行。Objective To explore the feasibility and safety of thoracoscopy plus individualized 3D-printed bioresorbable airway external stent for complex recurrent tracheoesophageal fistula(rTEF).Methods From January 2022 to August 2022,the relevant clinical data were collected for 7 rTEF children hospitalized at Department of Pediatric Surgery,Second Affiliated Hospital,Xi'an Jiaotong University.There were 5 boys and 2 girls with an age range of(4-120)month.According to the preoperative chest computed tomography(CT,0.5 mm),three-dimensional reconstruction of airway was performed and individualized bioresorbable airway external stent designed.The stent was fabricated by 3D printing at State Key Laboratory of Manufacturing System Engineering.All patients underwent thoracoscopic repair of rTEF plus an implantation of 3D-printed bioresorbable airway external stent wrapped around trachea at the level of fistula and fixed to tracheal cartilage.Results All patients completed the operation smoothly.Operative duration was(120-200)min,postoperative mechanical ventilation time(5-11)day,PICU length of stay(6-13)day and total length of stay(14-37)day.During a follow-up period of(10-15)months,clinical symptoms disappeared and no rTEF was detected by esophagography.Conclusions Thoracoscopic repair of rTEF with an implantation of 3D-printed bioresorbable airway external stent can prevent recanalization and recurrence of rTEF.It is both safe and feasible.

关 键 词：气管食管瘘 胸腔镜 三维打印 生物可降解支架 

分 类 号：R726.5[医药卫生—儿科]