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目的回顾总结一期纠治婴幼儿先天性心脏病(先心病)伴气管狭窄的体会。方法 2001年8月至2005年11月,6例先心病伴气管狭窄的婴幼儿行一期手术矫治。手术年龄24 d～3岁;体重4.2～10.0kg,平均(7.98±2.03)kg。其中法洛四联症3例,1例伴肺动脉闭锁;室间隔缺损2例,1例伴主动脉缩窄;肺动脉吊带1例。所有病儿均在低温体外循环下行先心病纠治术,同时处理气管狭窄。结果术后早期1例左、右支气管均匀性狭窄,不能脱离呼吸机死亡。1例肺动脉吊带者术后顺利出院,3个月后出现气管内肉芽增生,家属放弃治疗。余4例术后恢复良好,随访6个月至4年,临床上无气促表现。超声复查心功能良好,其中3例经 CT 复查,显示气管吻合口通畅,无明显狭窄。结论先心病伴先天性气管狭窄,以一期手术治疗为好,不但术中在体外循环下纠治气管狭窄较安全,而且同时纠治先心病有利于手术后病儿康复。
Objective To review and summarize the experience of treating infantile congenital heart disease (congenital heart disease) with tracheal stenosis in the first phase. Methods From August 2001 to November 2005, 6 infants with congenital heart disease and tracheal stenosis underwent primary surgery. The operative age ranged from 24 d to 3 years. The body weight ranged from 4.2 to 10.0 kg (mean, 7.98 ± 2.03) kg. Among them, 3 cases of tetralogy of Fallot, 1 case with pulmonary atresia; 2 cases of ventricular septal defect, 1 case with aortic constriction; 1 case of pulmonary artery sling. All sick children underwent hypothermic cardiopulmonary bypass heart disease correction surgery, while dealing with tracheal stenosis. Results In the early postoperative period, one case had left and right bronchial homogeneity narrow and could not die from the ventilator. One case of pulmonary artery stenosis was successfully discharged after surgery, and three months later, endotracheal granulation hyperplasia was found and relatives gave up treatment. The remaining 4 patients recovered well, followed up for 6 months to 4 years, no clinical manifestations of shortness of breath. Ultrasound review of cardiac function, of which 3 cases were reviewed by CT, showed anastomotic patency, no obvious stenosis. Conclusions Congenital tracheal stenosis with congenital tracheal stenosis is the best method for congenital tracheal stenosis. It is safe to treat tracheal stenosis during cardiopulmonary bypass, and correcting congenital heart disease is beneficial to the recovery of postoperative children.