Outcomes of slide tracheoplasty in 101 children: A 17-year single-center experience
Outcomes of slide tracheoplasty in 101 children: A 17-year single-center experience
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DOI：
10.1016/j.jtcvs.2014.02.069
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发表时间：
2014-06-01
影响因子：
6
通讯作者：
Elliott, Martin J.
中科院分区：
文献类型：
--
作者：
Butler, Colin R.;Speggiorin, Simone;Elliott, Martin J.
目的：我们的研究描述了手术滑动气管成形术（STP）治疗儿童长段气管狭窄的结果。方法：收集1995年2月至2012年12月期间接受STP的儿童的人口统计学和术前条件，手术细节和结局指标，包括内镜气道干预的需要和死亡率。结果：101例患者（中位年龄，5.8个月;范围，5天-15岁）接受STP。72例患者（71.3%）有相关的心血管异常。56例患者（55.4%）需要术前通气，而10例患者（9.9%）需要体外膜肺氧合。39例（38.6%）患儿存在异常支气管分支，其中13例（12.8%）为异常右上叶支气管，17例（16.8%）为气管三分叉。24例患者（23.7%）的气道狭窄扩展到一个或两个支气管，24例患者（23.7%）存在术前软化。47例（46.5%）STP延伸至支气管。总生存率为88.2%（12例患者死亡）。45例患者（44.6%）需要STP后球囊扩张，22例患者（21.8%）需要支架植入术。多变量分析显示，术前体外膜肺氧合（P <0.05）、术前软化（P <0.001）和支气管狭窄（P <0.05）是生存率的不良预测因素。术前软化是支架植入术的显著危险因素（P <0.05）。结论：STP是一种多功能和可靠的技术，与以前的策略相比，用于儿童长段气管狭窄的发病率和死亡率较低。术前支气管软化的存在是死亡和术后支架植入的重要危险因素。
Objective: Our study describes the results from surgical slide tracheoplasty (STP) in children with long segment tracheal stenosis.Methods: Demographic and preoperative conditions, operative details, and outcome measures, including the need for endoscopic airway intervention and mortality, were collected for children undergoing STP between February 1995 and December 2012.Results: One hundred one patients (median age, 5.8 months; range, 5 days-15 years) underwent STP. Seventy-two patients (71.3%) had associated cardiovascular anomalies. Preoperative ventilation was necessary in 56 patients (55.4%), whereas extracorporeal membrane oxygenation was required in 10 patients (9.9%). Abnormal bronchial arborization was present in 39 children (38.6%), which included 13 patients (12.8%) with an anomalous right upper lobe bronchus and 17 patients (16.8%) with tracheal trifurcation. Airway stenosis extended into 1 or both bronchi in 24 patients (23.7%) and preoperative malacia was present in 24 patients (23.7%). STP was extended into the bronchus in 47 patients (46.5%). Overall survival was 88.2% (mortality in 12 patients). Post-STP balloon dilation was necessary in 45 patients (44.6%) and stenting was required in 22 patients (21.8%). Multivariate analysis revealed preoperative extracorporeal membrane oxygenation (P < .05), preoperative malacia (P < .001), and bronchial stenosis (P < .05) to be adverse predictors of survival. Preoperative malacia was a significant risk factor for stenting (P < .05).Conclusions: STP is a versatile and reliable technique associated with low morbidity and mortality when compared with previous strategies for children with long segment tracheal stenosis. The presence of preoperative bronchomalacia is a significant risk factor for death and postoperative stenting.