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Objective:To study the changes of stenotic segment trachea diameter, trachea length and carina angle before and after slide tracheoplasty.Methods:From January 2010 to January 2018, 77 children with congenital tracheal stenosis(female=36) with complete clinical data accepted slide tracheoplasty in Shanghai Children's Medical Center were selected as the observation group. The diameter of stenosis segment, the length of stenosis segment, the full length of trachea and carina angle were measured by CT image, and the ratio of stenosis segment length to full trachea length was calculated. A group of children with normal trachea morphology and the same sample number, and they had no significant difference in age, height and weight were selected as the control group.Results:The median operative age of 77 children in the observation group was 1.3(1.1, 1.9)years old, the height was 76.0(72.0, 83.0)cm, and the weight was 9.0(7.9, 10.8)kg. The age, height and weight of 77 children in the control group were 1.5(1.0, 2.0) years old and 78.0(71.0, 85.0) cm, 9.2(7.9, 11.0) kg respectively. After slide tracheoplasty, the diameter of trachea in the stenotic segment of children increased from 2.7 mm to 4.4 mm, which was increased by 63.0%( P<0.001), but still smaller than that of children in the control group(6.1 mm). The average length of trachea was shortened by 0.7 cm( P<0.001), and there was no significant difference between the total length of trachea(5.4 cm) and the total length of trachea(5.5 cm). The postoperative carina angle decreased by 27.9°( P<0.001), there was no significant difference in postoperative carina angle between the observation group(93.0°) and the control group(90.7°). Conclusion:The diameter of reconstructed trachea in children with CTS is significantly increased, the length and carina angle of trachea become smaller after slide tracheoplasty. The morphology of trachea is more similar to children in the control group.
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Objective To explore the value of low-dose CT in the diagnosis of congenital heart disease(CHD)with tracheal stenosis (CTS)in infants.Methods Data of low-dose CT and echocardiography in 18 cases of CHD with CTS were analyzed retrospectively, and compared with surgical findings.Results 18 cases of CST were comfirmed by surgical operation.The diagnostic accuracy of low-dose CT was 100%,and there was no statistical difference in the assessment of the range and degree in tracheal stenosis(P=0.76>0.05, P=0.767>0.05).42 cardiac anomalies were comfirmed by operation.The diagnostic accuracies of low-dose CT and echocardiography were 88.1% and 90.5% respectively,which was no statistical difference(P=0.825>0.05).15 cases of CTS(15/18,83.33%)were caused by the compression of the vessels,in which there were 9 cases by pulmonary artery sling,3 cases by vascular ring,3 cases by double aortic arches.Conclusion Low-dose CT can accurately diagnose CHD with CTS and provide important information for clinical practice.
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Major congenital malformations affecting the larynx and trachea are laryngomalacia, vocal cord paralysis, subglottic hemangioma, congenital laryngeal web, laryngotracheal cleft, congenital tracheal stenoses, tracheal and bronchomalacia. The most frequent acquired diseases are stenotic lesions, mainly subglottic stenosis. In this chapter the main anomalies affecting the airway of children and adolescents are described, emphasizing the importance of early and accurate diagnosis as well as defining the modern treatment options.
Las principales malformaciones congénitas que afectan la laringe y tráquea son la laringomalacia, parálisis de cuerdas vocales, hemangioma subglótico, web laríngeo, hendidura laringotraqueal, estenosis traqueal congénita, traqueo y broncomalacia. Las lesiones adquiridas que con mayor frecuencia debemos diagnosticar y tratar son las lesiones post intubación, principalmente la estenosis subglótica. En este capítulo se describen estas afecciones de la vía aérea del niño, haciendo énfasis en la importancia de un diagnóstico precoz y preciso además de definir las alternativas modernas de tratamiento.
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Humans , Child , Laryngeal Diseases/surgery , Tracheal Diseases/surgeryABSTRACT
Objective To investigate the operation method for congenital tracheal stenosis(CTS) with vascular ring(VR),in order to minimize surgical risk.Methods The data of 53 VR patients diagnosed by CT imaging,fiber bronchoscope and color doppler echocardiography were analyzed retrospectively.The age ranged from 5.0 days to 2.5 yeas old,median age was 12.5 months,including pulmonary artery sling,double aortic arch,right arch combined with abnormal left subclavian artery and innominate artery oppression,et al,in which 12 patients (8 male,4 female) associated with CTS symptoms.All patients were treated by operations,8 patients were dead,others were followed up for 3 to 5 years at 6-month interval.Results Fifty-three patients with VR were categorized into 2 treatment groups.There were 41 patients(25 male,16 female) without CTS symptoms treated by VR repair(3 cases died),mortality was 7.3％.Of the 12 patients(8 male,4 female) with VR + CTS symptoms,7 cases were treated by selective VR repair with 2 cases deaths,5 cases underwent combined V R and CTS repairs with 3 cases died,for an overall mortality of 41.7 ％.Of the 41 patients with VR but no CTS,7 cases had intracardiac anomalies with 2 cases died.In contrast,3 of 12 patients with VR + CTS and intracardiac anomalies with 2 cases died;5 patients received cardiac and CTS repairs(3 cases died) and 7 cases in selective VR repairs(2 cases died).Conclusions Not all cases of TN associated with VR require combined correction.CTS and the combined cardiac abnormalities increased the risk of VR surgery in children.The individualized treatment program should be developed for such children.
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Introducción: La estenosis traqueal congénita (ETC) es una entidad clínica infrecuente, que se caracteriza por la presencia de anillos traqueales circulares completos, que determinan estrechez fija del lumen traqueal ocasionando dificultad respiratoria de grado variable. Objetivos: Comunicar 10 pacientes portadores de ETC, sus aspectos clinicos, morfológicos y alternativas en el tratamiento. Pacientes y Método: Se analizó retrospectivamente las formas de manifestación, exámenes diagnósticos y evolución de diez pacientes portadores de ETC diagnosticados entre los años 1998 y 2006. Resultados: Seis pacientes con síntomas respiratorios graves requirieron cirugía correctora de la traquea, uno falleció luego de un año, en el postoperatorio de una intervención cardiovascular. Cuatro pacientes con sintomatología respiratoria menor no requirieron corrección quirúrgica, uno falleció en el postoperatorio de una cirugía cardiaca. Conclusión: La ETC es una malformación potencialmente grave que requiere tratamiento quirúrgico en los pacientes sintomáticos con obstrucción severa de vía aérea. Los pacientes con síntomas leves pueden permanecer en control y no ser sometidos a cirugía correctora.
Congenital tracheal stenosis (CTS) constitutes an uncommon disease, characterized by the presence of complete tracheal rings that determine a fixed narrow tracheal lumen with different levels of respiratory distress. Objective: To expose 10 patients with CTS in relation to their morphological-clinical aspects and treatment alternatives. Method: Retrospective analysis of these patients diagnosed with CTS between 1998 and 2006, in terms of clinical evolution and diagnostic exams. Results: 6 patients with severe respiratory symptoms needed corrective tracheal surgery; one of them died one year later during cardiac surgery. 4 patients with mild respiratory symptoms did not require tracheal surgery; one of them died during cardiac surgery. Conclusion: CTS is a serious malformation that requires surgical treatment in those patients with severe airway obstruction. Patients with mild symptoms are observed closely without the need for surgery.
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Objective: Slide tracheoplasty seems to be the most efficient surgical procedure for correcting long-segment funnel-shaped congenital tracheal stenosis. However, in cases of extremely long-segment or those involve carina, slide tracheoplasty when operated alone has certain degree of limitations which often need additional operative procedure. The authors report a technique of slide tracheoplasty in combination with pericardial patch augmentation in a child with congenital tracheal stenosis involving the carina. Methods: A 3-month-old girl, previously diagnosed with Tetralogy of Fallot and congenital tracheal stenosis, presented with severe cyanosis and serious major airway obstruction after a few days of upper respiratory tract infection (URI). Because of the failure to maintain her ventilation with a high positive pressure ventilator, an emergency slide tracheoplasty with a modified right Blalock’s Taussig shunt was performed under a cardiopulmonary bypass. The intraoperative finding revealed a complete tracheal ring stenosis involving the lower half of the trachea and carina. It was transected at the middle and a vertical incision was made at the posterior wall of the upper trachea and anterior wall of the lower and extended into orifices of the main bronchus. The upper and lower tracheal flaps were slid together and sutured with interrupted Proline 5-0. Consequently, she still had significant obstruction of the main bronchi postoperatively and needed a re-operation two days later. Under cardiopulmonary bypass support, the lower anastomotic sutures were removed and an additional bronchial incision was made into the main bronchus. The anterior upper tracheal flap was separated into two, and each equal flap was pulled down and sutured to the main bronchus. Then an autologous pericardial patch was used to cover all the airway defects. Intraoperative fiberoptic bronchoscopy demonstrated adequate tracheo-bronchial lumen. Results: The child had postoperative hyperactive airway reaction and needed prolonged ventilator support and tracheostomy for tracheal toileting. Repeated postoperative bronchoscopy found moderated granulation tissue which was easily removed by catheter suction. Unfortunately, the patient expired six months after the surgery due to uncontrolled sepsis. However, a bronchoscopic finding before the patient’s death revealed adequate major airway patency. Conclusion: Combined slide tracheoplasty with pericardial patch augmentation made reconstruction of the complex congenital tracheal stenosis involving carina or tracheal bronchus possible and minimized the result of unflavoric excessive granulation tissue forming caused by pericardial tracheoplasty alone.
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A 41-year-old female was admitted to our hospital for self-audible wheezing sound and dyspnea. On past history, she has been suffered from chest discomfort, and treated recurrently by other hospitals. But, there was no symptomatic improvement. A stridor and mixed wheezing sound was auscultated on whole lung field. PFT revealed fixed type or variable intra- & extra-thoracic air way obstructive pattern. By bronchoscopy & bronchogram, we found web-like structure on the distal trachea. A bronchoplasty was performed and the post-operative PFT showed slight improvement & she had no more complaints.