摘要
目的探讨先天性气管狭窄(congenital tracheal stenosis,CTS)患儿滑片吻合术(slide tracheoplasty,STP)重建气管术后3年气管直径的增长情况。方法回顾性分析上海儿童医学中2013年1月至2017年12月接受滑片吻合术患儿的临床和随访资料。有术前、后CT和纤维支气管镜检查图像和报告及术后1、6、12、24、36个月随访CT图像和报告的患儿被纳入研究队列,作为STP治疗组。测量术前气管狭窄段最小直径,记录随访期间重建气管最小直径。并根据患儿年龄、身高、体重等条件选取有上海儿童医学中心体检胸部CT检查的气管正常儿童作为对照组,对比观察CTS术后患儿与正常儿童气管直径的差异。结果STP治疗组纳入43例患儿,其中男19例,女24例;手术年龄为(1.7±1.3)岁。患儿术前狭窄段最小直径为(2.6±0.7)mm,术后增至(4.4±1.2)mm,P<0.001。术后3年为(5.7±1.2)mm,重建气管直径随时间的延长而显著增加(P<0.001)。随访3年气管直径增长速度为(0.4±0.2)mm/年。其中术后前6个月气管直径生长速度最快为(0.8±0.7)mm/年,第1年为(0.7±0.6)mm/年,第2年为(0.3±0.3)mm/年,第3年为(0.3±0.3)mm/年。线性回归分析表明,滑片吻合术后3年重建气管直径均随年龄(R^(2)=0.284,P<0.001)、身高(R^(2)=0.241,P<0.001)、体重(R^(2)=0.188,P<0.001),增加而显著增加。结论STP不会抑制重建气管的生长。重建气管直径生长与年龄、身高、体重增长呈正相关。滑片吻合术后随访3年,前6个月气管生长较快,此后气管生长速度减慢。
Objective To explore the expansion of tracheal diameter 3 years after slide tracheoplasty(STP)in children with congenital tracheal stenosis(CTS).Methods From January 2013 to December 2017,clinical and follow-up data were retrospectively reviewed for children undergoing STP.Imaging studies of computed tomography(CT)and fiberoptic bronchoscopy were performed at pre-operation and 1,6,12,24 and 36 months post-operation.The minimal diameter of tracheal stenosis was measured preoperatively and minimal diameter of reconstructed trachea recorded during follow-ups.Children with normal trachea were selected as control group according to age,height and weight.The differences of tracheal diameter between CTS children and normal controls were compared.Results There were 19 boys and 24 girls with an average operative age of(1.7±1.3)years.The mean minimal diameter of stenotic segment was(2.6±0.7)mm at pre-operation,(4.4±1.2)mm at post-operation and(5.7±1.2)mm at 36 months at post-operation.The diameter of reconstructed trachea expanded significantly with time(P<0.001).During 3-year follow-ups,the average growth rate of tracheal diameter was(0.4±0.2)mm per year.The average growth rate of tracheal diameter was(0.8±0.7)mm per year in the first 6 months,(0.7±0.6)mm per year in the first year,(0.3±0.3)mm per year in the second year and 0.3±0.3 mm per year in the third year.Linear regression analysis indicated that,at3 years post-STP,the diameter of reconstructed trachea expanded significantly with age(R^(2)=0.284,P<0.001),height(R^(2)=0.241,P<0.001)and weight(R^(2)=0.188,P<0.001).Conclusions STP does not suppress the growth of reconstructed trachea.The diameter growth of reconstructed trachea is correlated positively with age,weight and height.The growth rate of trachea is faster in the first 6 months within 3 years after STP and then slowed down.
作者
温皖豫
杜欣为
王顺民
徐志伟
陆兆辉
Wen Wanyu;Du Xinwei;Wang Shunmin;Xu Zhiwei;Lu Zhaohui(Department of Cardiothoracic Surgery,Shanghai Children's Medical Center,School of Medicine,Shanghai Jiao Tong University,National Children's Medical Center,Shanghai 200127,China)
出处
《中华小儿外科杂志》
CSCD
北大核心
2022年第10期884-889,共6页
Chinese Journal of Pediatric Surgery
基金
浦东新区科技发展基金(PKJ2020-Y02)。
关键词
气管狭窄
先天性心脏病
滑片吻合术
气管生长
随访
Tracheal stenosis
Congenital heart disease
Slide tracheoplasty
Tracheal growth
Follow-up
