Abstract:
Despite improving the survival after repair of esophageal atresia (EA), the morbidity of EA repair remains high. Specifically, tracheomalacia (TM) is one of the most frequent complications of EA repair. Continuous positive airway pressure is generally applied for the treatment of TM. However, surgical intervention is required against an apparent life-threatening event or inability to perform extubation for a long period. According to our review, most cases of TM showed symptom improvement after aortopexy. The ratio of the trachea\'s lateral and anterior-posterior diameter at the brachiocephalic artery crossing the trachea, which reflects the compression of the trachea by the brachiocephalic artery, is a good indicator of aortopexy. Our finding suggests that most TM cases associated with EA may not be caused by tracheal fragility alone, but may involve blood vessel compression. Posterior tracheopexy (PT) is also an effective treatment for TM. Recently, open or thoracoscopic PT was able to be performed simultaneously with EA repair. In many cases, aortopexy or PT is a safe and effective surgical treatment for TM with EA. Other surgical procedures, such as external stenting, should be considered for patients with diffuse-type TM for whom aortopexy and PT appear relatively ineffective.
摘要:
尽管改善了食管闭锁(EA)修复后的生存率,EA修复的发病率仍然很高。具体来说,气管软化(TM)是EA修复最常见的并发症之一。持续气道正压通常用于治疗TM。然而,对于明显危及生命的事件或长时间无法进行拔管,需要进行手术干预.根据我们的审查,大多数TM病例显示主动脉固定术后症状改善。穿过气管的头臂动脉的气管外侧和前后直径之比,这反映了头臂动脉对气管的压迫,是主动脉固定术的良好指标.我们的发现表明,大多数与EA相关的TM病例可能不是由气管脆性引起的,但可能涉及血管压迫。后气管固定术(PT)也是TM的有效治疗方法。最近,开放或胸腔镜PT能够与EA修复同时进行。在许多情况下,主动脉固定术或PT是TM合并EA的安全有效的手术治疗方法。其他外科手术,例如外部支架,对于弥漫型TM患者,主动脉固定术和PT相对无效,应考虑。