目的:目的是报告和分析开放式主动脉固定术和胸腔镜主动脉固定术治疗小儿气道软化症的特点和结果。
方法:我们报告了2006年12月至2021年1月在四级转诊中心接受主动脉固定术治疗气道软化症的儿科患者的回顾性连续病例系列。结果措施包括拔管天数,继续需要无创通气,以气管切开术和死亡的形式进行进一步干预。
结果:169例患者接受了主动脉固定术:147例接受了开放手术(135例通过正中/有限正中胸骨切开术和12例开胸手术)和22例胸腔镜手术。平均随访时间为8.46年(范围1-20年)。最常见的气道软化部位是气管(n=106,62.7%),48例(28.4%)支气管受累气管支气管软化症(TBM)。15例(8.9%)仅患有支气管软化症(BM)。胸腔镜组的支气管疾病发生率低于开放组(13.6%vs40.82%;p<0.0001)。平均拔管时间为1.45天,2.59天,气管软化5.23天,TBM和BM组,分别(p=0.0047)。平均拔管时间为1.35天,2天,3.67天,外血管压迫患者5天,TOF/OA,原发性气道软化症,和喉重建术,分别(p=0.0002)。整个队列中有21人死亡,所有人都在公开小组中。71.4%(n=15)的气道软化有支气管受累。
结论:开放和胸腔镜下主动脉固定术是治疗儿童气道软化症的有效方法。我们已经确定支气管受累是不良结局的危险因素,而这个患者队列的最佳治疗仍有争议。
方法:IV.
方法:回顾性研究。
OBJECTIVE: The objective was to report and analyse the characteristics and results of open
aortopexy and thoracoscopic
aortopexy for the treatment of airway malacia in a paediatric population.
METHODS: We report a retrospective consecutive case series of paediatric patients undergoing
aortopexy for the treatment of airway malacia at a quaternary referral centre between December 2006 and January 2021. Outcome measures included days to extubation, continued need for non-invasive ventilation, further intervention in the form of tracheostomy and death.
RESULTS: 169 patients underwent
aortopexy: 147 had open procedures (135 via median/limited median sternotomy and 12 thoracotomy) and 22 thoracoscopic. Mean follow up was 8.46 yrs (range 1-20 yrs). Most common site of airway malacia was the trachea (n = 106, 62.7 %), and 48 (28.4 %) had additional involvement at the bronchi with tracheobronchomalacia (TBM). 15 (8.9 %) had bronchomalacia (BM) only. Incidence of bronchial disease was lower in the thoracoscopic than open group (13.6 % vs 40.82 %; p < 0.0001). Mean time to extubation was 1.45 days, 2.59 days, 5.23 days in tracheomalacia, TBM and BM groups, respectively (p = 0.0047). Mean time to extubation was 1.35 days, 2 days, 3.67 days, and 5 days in patients with external vascular compression, TOF/OA, primary airway malacia, and laryngeal reconstruction, respectively (p = 0.0002). There were 21 deaths across the cohort, and all were in the open group. 71.4 % (n = 15) had bronchial involvement of their airway malacia.
CONCLUSIONS: Open and thoracoscopic
aortopexy are effective treatments for airway malacia in children. We have identified that involvement of the bronchi is a risk factor for adverse outcomes, and the optimum treatment for this patient cohort is still debatable.
METHODS: IV.
METHODS: Retrospective Study.