支气管镜在儿童Slide气管成形术中的应用

The role of bronchoscopy in slide tracheoplasty in children

摘要:

目的 总结支气管镜在儿童Slide气管成形术中的作用。方法 回顾性分析2017—2020年湖南省人民医院收治的4例气管狭窄患儿的诊疗经过，总结支气管镜在Slide气管成形术术前评估、术中定位与测量及术后创面评估和治疗中的作用。结果 Slide气管成形术术前支气管镜评估显示，4例患儿中3例存在完全气管环，2例合并肺动脉吊带，2例存在多处狭窄。3例在该院完成Slide气管成形术，术中支气管镜下判断狭窄段中点及测量狭窄段长度，协助离断气管狭窄段，术后灌洗明确病原；1例外院Slide气管成形术术后9个月出现瘢痕牵拉，经支气管镜下介入治疗好转。2例术后第4天支气管镜下发现气管黏膜改变，调整治疗方案；2例术后1个月出现肉芽增生，经支气管镜下冷冻治疗好转。1例因吻合口坏死放弃治疗死亡，存活的3例随访6个月以上，预后可，但均存在气管支气管软化。结论 支气管镜可用于气管狭窄患儿Slide气管成形术的管理，有助于术后康复及随访。

Abstract:

Objective To study the role of bronchoscopy in slide tracheoplasty.Methods A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty.Results Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia.Conclusions Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.