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小儿先天性心脏病伴气管狭窄的外科处理

Surgical treatment of congenital heart diseases with tracheal stenosis

摘要:

目的 探讨先天性心脏病伴气管狭窄患者的手术治疗方法及处理原则.方法 2006年1月至2013年6月共手术治疗先天性心脏病伴气管狭窄48例,男性36例,女性12例;手术时年龄3~72个月,平均(23 ±27)个月;体重3.4~46.0 kg,平均(12 ±8)kg.先天性心脏病类型包括:肺动脉吊带33例,双主动脉弓3例,法洛四联症6例,室间隔缺损4例,右心室双出口1例,肺动脉闭锁1例.气管狭窄类型:短段狭窄15例,长段狭窄25例,气管桥8例.手术方法包括:自体气管组织修复6例,狭窄段切除端端吻合11例,Slide方法31例,术后气管内肉芽生长,再次手术自体肋骨修补2例.术后分别在1、3、6、12个月进行随访,如有症状做气管镜检查.术后12个月复查CT.结果 48例先天性心脏病伴气管狭窄一期进行手术纠治,死亡7例,病死率14.6%.其中2例死亡与气管狭窄无关;余5例均为长段气管狭窄术后气管内肉芽形成所致.41例患者随访2个月至6年,气管狭窄症状消失,CT复查效果满意,无再次手术患者.结论 先天性心脏病伴气管狭窄一期手术纠治效果良好.长段气管狭窄采用Slide方法,疗效满意.术后气道内肉芽生长是患者死亡的主要原因.

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abstracts:

Objective To retrospectively analyze the experience of one-stage surgical correction for children with congenital heart diseases and tracheal stenosis and further to clear the principle of treatment for these patients.Methods From January 2006 to June 2013,48 patients with congenital heart diseases and tracheal stenosis underwent surgical correction.There were 36 male and 12 female patients.The mean age at operation was (23 ± 27) months (range:3-72 months) and the mean weight was (12 ± 8) kg (range:3.4-46.0 kg).The underlying diagnoses were pulmonary sling in 33 patients,double aortic arch in 3,tetrology of Fallot in 6,ventricular septal defect in 4,double outlet right ventricle in 1,and pulmonary atresia in 1 patient.Among them,short tracheal stenosis was present in 15,long tracheal stenosis in 25 and bridging bronchus in 8 patients.Repairs with autogenous tracheal tissue were performed in 6,and end-to-end anastomosis in 11 and slide tracheoplasty in 31 patients.Two patients had granulation tissue growing in the airway postoperatively and were re-operated by autogenous rib tissue.All of patients were followed up after operation 1,3,6,12 months and if the patient had symptoms that should be examined by bronchoscopy.The patients should be examined by CT post-operation one year.Results There were 7 deaths in all 48 cases and the early mortality was 14.6%.Two deaths were not related to tracheal stenosis,and other 5 were associated with long segment tracheal stenosis.Forty-one patients were followed for 2 months to 6 years,and no patients required re-operations.Clinical symptoms of tracheal stenosis disappeared and the results of CT scan were satisfied.Conclusions One stage surgical repair of the patients with congenital heart diseases and tracheal stenosis have a good effect.Slide tracheoplasty is the effective surgical method for long segment tracheal stenosis.Postoperative granulation tissue growing in the airway is the leading cause of death.

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