摘要
目的探讨儿童气管、支气管软化的病因和气道管理方法。方法对671例儿童进行支气管镜检查，对发现气管软化和支气管软化的病例进行病因分析，并对他们的治疗加以总结。结果（1）通过支气管镜共发现气管、支气管软化的患儿148例，其中气管软化77例，支气管软化71例。（2）气管软化中：46例为血管环畸形，11例与先天性气道畸形有关，10例合并有先天性食管闭锁伴食管气管瘘，6例与气管切开造口和机械通气相关，4例为孤立性气管软化。（3）支气管软化中：64例患有心血管畸形，6例与先天性气道畸形有关，1例为孤立性支气管软化。（4）10例异常无名动脉患儿行主动脉固定术，12例右位主动脉弓伴迷走左锁骨下动脉和双主动脉弓患儿行血管环松解术，6例肺动脉吊带的患儿行肺动脉吊带纠治术；手术中直接切除严重的气管软化段的4例。38例患儿行机械通气，4例患儿进行气管造口，治疗气管软化和支气管软化，相当程度地缓解了症状。2例在支气管内进行金属支架植入治疗支气管软化，1例获得成功，另1例需要2次植入支架；这2例患儿均在以后进行了支架远端球囊扩张。结论心血管畸形是儿童发生气管、支气管软化的主要原因。对心血管畸形进行纠治后，大多数病例症状在6个月内逐渐改善。对严重的病例，治疗还包括机械通气和气管造口。支气管内支架植入可运用于难治性的病例中，但有一定的局限性。
Objective To investigate etiology and airway management in children with tracheobronchomalacia. Method Bronchoscopic examinations were performed in 671 children. The cases with tracheomalacia and bronchomalacia were analyzed in etiopathogenisis and summarized their therapy simultaneously. Result Bronchoscopic examination indicated tracheomalacia and bronchomalacia in 148 cases, tracheomalacia in 77 cases and bronchomalacia in 71 cases. Among the cases with tracheomaJacia, compression by vascular rings was found in 46 cases, incorporated congenital esophageal atresia with tracheoesophageal fistula was found in 5 cases, tracheomalacia was associated with tracheostoma and mechanical ventilation in 6 cases, with congenital airway malformation in 11 cases and isolated tracheomalacia was found in 4 cases. Among the cases with bronchomalacia, incorporated congenital cardiovascular malformation was found in 64 cases, congenital airway malformation in 6 cases and isolated bronchomalacia in 1 case. Ten children with anomalous innominate artery underwent aortopcxy, twelve children with dextro-aorta arch with concomitant aberrant left subclavian artery and double aorta underwent arches vascular ring lysis, six children with pulmonary sling underwent plasty. Severe malacia segments were resected directly in four children during operation. Mechanical ventilation was performed in 38 children. Tracheostoma was performed in 4 children to treat tracheomalacia and bronehomalacia, it could relieve symptom to a certain extent. In 2 children metal stents were inserted into the bronchus for the treatment of bronchomalacia, one was successful and the other needed re-insertion of stent again, these two patients underwent balloon-dilatation in distal part of stent afterwards. Conclusion The congenital cardiovascular malformation was the main reason to develop tracheobronchomalacia in children. The symptom of majority of the cases with cardiovascular malformation would be improved within 6 months after surgical intervention. In severe cases, treatments included mechanical ventilation and tracheostoma. Stenting could be applied in refractory cases, but it had certain limitations.
出处
《中华儿科杂志》
CAS
CSCD
北大核心
2009年第2期87-90,共4页
Chinese Journal of Pediatrics
关键词
气管
支气管
心血管畸形
儿童
Trachea
Bronchi
Cardiovascular malformation
Child
