手术治疗肺动脉吊带合并气管狭窄15例的疗效分析

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)

肺动脉吊带; 气管狭窄; 外科手术

Surgical treatment of pulmonary artery sling with tracheal stenosis in children: a report of 15 cases.
Zhou Wenwu1, Wu Ming1, Zhang Zhigong1, Cheng Fei1, Zhou Yafu1, Chen Renwei2, Liu Pingbo 2.

1.Department of Cardiothoracic Surgery, Hunan Provincial People's Hospital, Changsha 410005, China; 2.Department of Cardiothoracic Surgery, Hunan Children's Hospital, Changsha 410007, China.Corresponding author: Zhang Zhigong, Email: long_bow@163.com

Pulmonary Artery Sling; Tracheal Stenosis; Surgical Procedures,Operative

DOI: 10.3969/j.issn.1671— 6353.2017.06.013

备注

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 children 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 underwent 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 outcomes for left pulmonary re-implantation alone are acceptable in children with mild or moderate tracheal stenosis. However, slide tracheoplasty is required for some cases with severe long-segment tracheal stenosis.