先天性心脏病合并气管狭窄患儿的术后气道护理

目的探讨先天性心脏病合并气管狭窄患儿的术后气道护理策略。方法对26例先天性心脏病合并气管狭窄患儿行矫治心血管畸形术,同时2例行气管重建,1例放置气管支架,其余患儿未处理气管。术后加强有创通气护理、无创通气护理,保持患儿镇静,注重体位护理及气道管理。结果患儿术后行有创呼吸机辅助通气时间24~139(51.0±18.0)h。11例气管导管拔管后出现烦躁、吸气困难,给予开放气道、镇静及雾化吸入,其中8例患儿症状缓解,另3例需要CPAP辅助通气。1例术后死于多脏器功能衰竭。术后随访5~37(21.0±5.2)个月,1例术中放置气管支架患儿术后1个月突然死于气道大出血,生存患儿中3例仍有活动后气喘,其余患儿无明显呼吸道症状。结论对先天性心脏病合并气管狭窄患儿术后细致周密的气道护理,能够提高手术成功率、减少并发症,促进患儿早日康复。     

儿童先天性气管狭窄外科治疗进展

先天性气管狭窄是一种罕见却严重威胁患儿生命的疾病。近年来,手术技能的提高使得患儿术后并发症发生率和病死率显著减少。本文介绍先天性气管狭窄的病理、分型、常用手术方法等,总结气管成形术的手术适应证,以期对先天性气管狭窄的治疗提供一定建议。     

婴幼儿先天性气管狭窄合并先天性心脏病一期手术纠治

目的总结婴幼儿先天性气管狭窄伴先心病一期纠治经验和效果。方法回顾性分析2012年我院收治的12例先天性气管狭窄合并先心病患儿的临床资料。患儿平均年龄15.75月,平均体重9.38 kg。所有病例均在浅低温或中低温体外循环下行先心病纠治术,同时行气管成形术。结果所有患儿手术均成功,其中10例采用Slide气管成形法,2例采用端端吻合法。术后并发症包括肺炎4例,气道分泌物增多5例,气道高反应4例,肉芽组织生长3例,其中2例最终呼吸衰竭死亡;其余患者术后恢复良好。结论小儿先天性气管狭窄的处理仍较困难,Slide手术方法是目前处理主气管狭窄的最佳手术方式,特别适合于长段和弥漫性气管狭窄的患者。但是,先天性气管狭窄患者的治疗仍需要以气管成形手术为中心的综合治疗。     

喉罩在先天性心脏病伴气管狭窄患儿麻醉中的应用

先天性心脏病(先心病)伴气管狭窄,以往在先心病矫治术时气管狭窄不做处理,有些患儿会为此发生术后脱机困难;如果气管狭窄行一期矫治手术(去除狭窄段断端吻合术或补片扩大管径术等),手术创伤大,死亡率高[1],本文采用喉罩全麻下先心病矫治术联合纤支镜介入技术,检查评估先心病矫治术后气管狭窄改善情况,对中、重度气管狭窄患儿行纤支镜下球囊扩张、气管支架置入术等治疗,取得了很好     

儿童先天性气管狭窄外科治疗中国专家共识北大核心CSCD

本共识从儿童先天性气管狭窄围手术期的诊断和治疗出发, 制定了我国在该领域的第一个相对统一的外科诊治标准, 为推动我国儿童先天性气管狭窄外科治疗的整体发展提供理论保障。     

先天性心脏病合并气管狭窄一例

患者 男，5岁。出生后发现心脏杂音，反复发生呼吸道感染、活动后心悸、气促，心功能Ⅲ级。入院后查体：心前区可闻及3／6级连续性机械样杂音，肺动脉瓣第二心音（P2）亢进。经心血管造影、心脏超声心动图和胸部X线片等检查，确诊为先天性室间隔缺损，动脉导管未闭，主动脉缩窄，肺动脉高压。     

婴幼儿先天性心脏病伴气管狭窄的一期矫治

目的回顾总结一期纠治婴幼儿先天性心脏病（先心病）伴气管狭窄的体会。方法2001年8月至2005年11月，6例先心病伴气管狭窄的婴幼儿行一期手术矫治。手术年龄24d～3岁；体重4．2～10．0kg，平均（7．98±2．03）kg。其中法洛四联症3例，1例伴肺动脉闭锁；室间隔缺损2例，1例伴主动脉缩窄；肺动脉吊带1例。所有病儿均在低温体外循环下行先心病纠治术，同时处理气管狭窄。结果术后早期1例左、右支气管均匀性狭窄，不能脱离呼吸机死亡。1例肺动脉吊带者术后顺利出院，3个月后出现气管内肉芽增生，家属放弃治疗。余4例术后恢复良好，随访6个月至4年，临床上无气促表现。超声复查心功能良好，其中3例经CT复查，显示气管吻合口通畅，无明显狭窄。结论先心病伴先天性气管狭窄，以一期手术治疗为好，不但术中在体外循环下纠治气管狭窄较安全，而且同时纠治先心病有利于手术后病儿康复。     

气管切开术后护理进展

气管切开术已有2000多年的历史,其传统的适应证是解除喉及气管上端阻塞,被认为是一种抢救性的急症手术。但近年来,因为其它病因所行的气管切开术已大大超过了上呼吸道阻塞因素,其作为一种抢救手段,已越来越多地应用于各种疾病的治疗中。气管切开术后护理质量的好坏,直接关系到手术的成败和病人的预后。现将气管切开术后护理进展综述如下。     

先天性食管狭窄的诊断和治疗

目的 根据病理结果，探讨小儿先天性食管狭窄的早期诊断和改良的治疗方案。方法 回顾性分析1980～2000年42例先天性食管狭窄病例的呕吐发生年龄、频率，对营养、发育的影响，诊断治疗方法及病理所见，术后正常进食时间，远期营养恢复。结果 经食管镜、消化道造影、手术病理证实，气管软骨异位26例，肌层肥厚11例，膜式狭窄3例，异位胃黏膜2例。42例中11例先行扩张治疗者仅1例膜式狭窄扩张成功；41例手术治疗，10例端端吻合，12例食管胃吻合，19例纵切横缝。9例术后扩张。扩张3个月以上者占55．6％。膜式狭窄、气管软骨异位术后见效快，大多无需扩张。肌层肥厚多数需术后扩张，但随访4～10年效果良好。术后病程1个月即恢复正常进食者达78．6％，6个月9．5％，1年始恢复者为11．9％。结论 注意添加辅食时频繁呕吐影响营养、发育者，可早发现本病；食管镜、消化道造影是诊断依据。膜式狭窄、气管软骨异位，纵切横缝效果好。肌层肥厚行狭窄段切除端端吻合是基本治疗方法；术后1个月扩张疗效满意。     

Slide tracheoplasty for congenital tracheal stenosis

Background/purpose

The aim of this study was to add to the experience of slide tracheoplasty in infants with congenital tracheal stenosis (CTS), to review the recent literature on this subject, and to evaluate the diagnostic workup in infants with CTS.

Methods

A retrospective review of 3 infants with CTS treated with slide tracheoplasty was conducted at our institution. They all underwent bronchoscopy, tracheobronchography, and echocardiography. Therapy consisted of slide tracheoplasty and simultaneous correction of associated vascular malformations.

Results

A pulmonary artery sling was missed initially on esophagography in 2 patients. Stridor became worse in 2 patients after tracheobronchography. After surgical therapy, 2 patients survived and were discharged 12 days after surgery. Both are without symptoms at follow-up of 12 and 20 months. One patient had inoperable restenosis and died 27 days after the operation.

Conclusions

Esophagography is not a reliable tool to depict associated vascular anomalies for patients with CTS. According to the literature, computer tomography has become more reliable to depict the tracheobronchial tree and is useful to elucidate associated vascular anomalies as well. Compared with other surgical techniques for infants with CTS reported in the literature, slide tracheoplasty has fewer postoperative complications and comparable survival rates.     

Anterior pericardial tracheoplasty for congenital tracheal stenosis

Congenital tracheal stenosis may be a life-threatening anomaly not relieved by airway intubation. Over the past 7 years, anterior pericardial tracheoplasty has been used at our institution for treatment of congenital long-segment tracheal stenosis in infants with impeding airway obstruction. Case histories of eight patients undergoing nine anterior pericardial tracheoplasties have been reviewed to assess this technique. Of these patients, six have required preoperative tracheal intubation before repair to maintain ventilation. The surgical technique of anterior pericardial tracheoplasty includes a median sternotomy approach with partial normothermic cardiopulmonary bypass. An anterior tracheotomy through all hypoplastic rings allows enlargement with autologous pericardium to 1.5 times the predicted normal diameter. After insertion, the pericardium and hypoplastic tracheal cartilages are suspended to surrounding mediastinal structures, which prevents airway collapse. Seven of eight infants have survived without tracheoplasty dehiscence or wound infections. Five were ultimately extubated and are currently free of symptoms from 6 months to 5 years after anterior pericardial tracheoplasty. The other two survivors had residual stenosis as a result of complications of prior tracheostomy. One of these patients has undergone a successful second anterior pericardial tracheoplasty and is currently extubated and well. The other is palliated at 6 months with a tracheostomy awaiting a second anterior pericardial tracheoplasty. Our review of anterior pericardial tracheoplasty has demonstrated the safety, utility, and at least medium-term benefit of this procedure in infants of any age and weight.     

Esophageal tracheoplasty for congenital tracheal stenosis.

Two infants with congenital long tracheal stenosis underwent operation by means of an esophageal tracheoplasty. The first patient had previously undergone tracheal reconstruction using the pericardium. Although ventilation improved somewhat following this procedure, the pericardial patch suddenly ruptured 12 days after the operation, requiring an immediate esophageal tracheoplasty. The esophageal portion of the reconstructed trachea epithelialized 1 month later, with the lumen maintaining its proper size. However, the patient died 3 months after the second tracheoplasty. The cause of death was thought to be due to complications arising from prolonged high-pressure use of mechanical ventilation. He had been on a respirator for 6 months before the first tracheoplasty. The second patient has been doing well with no recurring respiratory problems for 25 months now. Her reconstructed trachea has adapted with her growth. This technique should be considered along with other forms of treatment for tracheal reconstruction because it is relatively simple and pliable.     

Modified slide tracheoplasty for congenital tracheal stenosis

Slide tracheoplasty has become a standard procedure to treat long-segment congenital tracheal stenosis because it is a reasonable and simple technique. Slide tracheoplasty does not affect the carina during long-segment congenital tracheal stenosis management, and thus lesions of the carina, such as stenosis and tracheobronchomalacia can become important causes of extubation failure after surgery. In this manusript, we describe the effectiveness of our modified slide tracheoplasty, which includes reconstruction of the carina. We have performed this technique on three patients, all of whom were extubated without developing any respiratory symptoms.     

Slide tracheoplasty for congenital funnel-shaped tracheal stenosis

Congenital funnel-shaped trachea is a serious condition, and the survival rate in infants is poor. A slide tracheoplasty is described, with a brief review of other methods of repair. Two cases that demonstrate the operability of congenital funnel-shaped trachea in infancy are reported.     

Slide tracheoplasty for congenital tracheal stenosis: a case report

BACKGROUND/PURPOSE: A variety of techniques have been used to manage pediatric congenital tracheal stenosis. The authors report the technique of slide tracheoplasty for a child with long congenital tracheal stenosis. METHODS: A 2-year-old male presented with a history of stridor with feeding. Bronchoscopy findings showed 50% stenosis from complete cartilaginous rings, extending from 2.5 cm below the vocal cords to 2 cm above the carina. Through a neck incision, the trachea was exposed from the cricoid to both bronchi and transected at the midpoint of the stenosis. The upper trachea was split anteriorly to the area of stenosis just below the cricoid. The lower trachea was split posteriorly in the midline. Posterior dissection allowed sliding and anastomosis of both tracheal segments while the lateral vascular supply was left intact. A brace was placed to maintain cervical flexion, and the patient underwent extubation in the operating room. RESULTS: He recovered without complication and was dis charged on postoperative day 4. CONCLUSION: Slide tracheoplasty offers several advantages for tracheal reconstruction because it is performed with the native tracheal tissues, can be accomplished through a transverse collar incision, and can repair long stenoses without significant tracheal shortening.     

Slide tracheoplasty in infant with congenital tracheal stenosis and tracheomalacia after esophageal atresia with tracheoesophageal fistula repair

Slide tracheoplasty can be applied successfully to all types of long segment congenital tracheal stenosis. In case of short segment tracheal stenosis, direct resection and anastomosis is often preferred. We report a case illustrating a new side benefit of the slide tracheoplasty in a patient presenting a relatively short hypoplastic tracheal segment coexisting with tracheomalacia after EA with TEF repair.