The role of bronchoscopy in slide tracheoplasty in children / 中国当代儿科杂志

OBJECTIVES@#To study the role of bronchoscopy in slide tracheoplasty.@*METHODS@#A retrospective analysis was conducted on the diagnosis and treatment of four children with tracheal stenosis admitted to Hunan Provincial People's Hospital from 2017 to 2020. The role of bronchoscopy was summarized in the preoperative evaluation, intraoperative positioning and measurement, and postoperative wound evaluation and treatment during slide tracheoplasty.@*RESULTS@#Bronchoscopy evaluation before slide tracheoplasty showed that 3 of the 4 children had complete trachea rings, 2 had pulmonary artery sling, and 2 had multiple stenosis. Slide tracheoplasty was performed in the hospital on 3 children, and the midpoint of the stenosis segment was judged under bronchoscopy, and the length of the stenosis segment was measured, which assisted in the resection of the stenosis segment of the trachea. The pathogens were identified by lavage after the surgery. One child who developed scar traction 9 months after slide tracheoplasty in another hospital was improved by interventional treatment under bronchoscopy. Mucosal changes were found under bronchoscopy in 2 children 4 days after surgery, and the treatment plan was adjusted. One month after surgery, 2 children had granulation hyperplasia, which was improved by cryotherapy under bronchoscopy. One child abandoned treatment due to anastomotic necrosis and died. Three survivors were followed up for over 6 months with good prognosis, but all had tracheobronchial malacia.@*CONCLUSIONS@#Bronchoscopy can be used for the management of slide tracheoplasty in children with tracheal stenosis, which is helpful to postoperative rehabilitation and follow-up.

Morphologic improvements of trachea of children with congenital tracheal stenosis after slide tracheoplasty / 中华胸心血管外科杂志

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.

Surgical treatment of tracheal stenosis in children / 中华胸心血管外科杂志

Objective:To investigate the common types, surgical treatment and effects of tracheal stenosis in children.Methods:A total of 23 children with tracheal stenosis in our hospital from December 2017 to August 2020 were retrospectively reviewed, including 14 males and 9 females. The mean age at operation was(8.9±5.8)months(range: 2-3 months) and the mean weight was(6.4±2.3)kg(range: 4.2-10.5 kg). The common types of tracheal stenosis were complete tracheal ring in 9 children, tracheomalacia in 10 and subglottic membranous annular hyperplasia in 4. The type of congenital heart diseases included 10 patients of pulmonary artery sling, 1 of tetralogy of Fallot, 5 of ventricular septal defect, 1 of pulmonary atresia, and 1 of right aortic arch with aberrant left subclavian artery. Slide tracheoplasty was performed in 9 patients, external splint in 8, endotracheal stent in 2 and tracheal dilation in 4. All children were followed up after 1, 3, 6, and 12 months of operation with CT and bronchoscopy.Results:There was 1 death in all 23 patients and the mortality was 4.3%, which died of granulation tissue hyperplasia after slide tracheoplasty. Reoperation was performed in 1 patient with endotracheal stent. All patients were followed for 1 to 24 months. Clinical symptoms of tracheal stenosis disappeared and the results of CT and bronchoscopy were satisfied.Conclusion:Slide tracheoplasty is the effective surgical method for complete trachea ring. 3D printing bioresorbable external splint is a promising method for the treatment of tracheomalacia.

Simultaneous Repair of Pulmonary Artery Sling and Tracheal Stenosis in Neonate / 日本心臓血管外科学会雑誌

A 17-days-old-girl with pulmonary artery (PA) sling, patent ductus arteriosus (PDA), and persistent left superior vena cava was admitted to our hospital. Despite good respiratory status just after birth, the respiratory status gradually worsened, and tracheal intubation was performed on 13th day after birth. Emergency division of the PDA was conducted on day 16. Although preoperative computed-tomography did not demonstrate tracheal stenosis, bronchoscopy after tracheal intubation revealed progression of tracheal stenosis with difficulty for stable anesthetic management. Therefore, operation was postponed to re-evaluate tracheal stenosis. Bronchoscopy and computed-tomography revealed the worsening of tracheal stenosis. Eventually, we performed total correction of the PA sling and tracheal stenosis on day 17. Cardiopulmonary bypass was established after median sternotomy. After transection of the PDA, the left PA originating from the right PA was also transected, and transplanted to the main PA. Then, sliding tracheoplasty was performed following the division of the tracheal stenotic region. Her respiratory condition improved after operation, and postoperative computed-tomography showed successful correction of tracheal stenosis. Although few such cases were reported for neonatal PA sling requiring concomitant tracheoplasty, this case suggests that total correction of PA sling and tracheal stenosis is feasible and useful surgical procedure for such cases.

Successful Treatment of Tracheal Stenosis with Slide Tracheoplasty after the Failure of Resection with End-to-End Anastomosis

The combined effects of inhaled irritant gases and heat in burn patients can result in the development of laryngotracheal strictures. Several factors could adversely affect the development of tracheal stenosis and cause the growth of granulation tissue. Yet the current treatment options for this condition are limited because of the paucity of case reports. We report here on a case of a patient who experienced recurrent upper tracheal stenosis after an inhalation injury. She displayed repetitive symptoms of stenosis even after several laryngomicrosurgeries and resection with end-to-end anastomosis. Finally, 5 yr after the burn injury, slide tracheoplasty was successfully performed and the postoperative check-up findings and the increased airway volume seen on imaging were all satisfactory.

Two cases of congenital tracheal stenosis noteced before and after open heart surgery / 대한마취과학회지

Long, severe, and fixed congenital tracheal stenosis is a life-threatening anornaly and not relieved by endotracheal or tracheostomy intubation. The rarity of congenital tracheal stenosis has not allowed sufficient experience for the development of standard treatment methods, therefore, congenital tracheal stenosis still carries significant morbidity, with a mortality rate as high as 70%. We have followed up two patients managed by different methods, but O(2)-isoflurane-Fentanyl-vecuronium was used for induction and maintenace. We experienced one case of tracheoplasty with pericardial patch for extensive tracheal stenosis under extracorporeal circulation, and one case of slide tracheoplasty for funnel-shaped tracheal stenosis. The first case was noticed incidentally during anesthetic induction and the vocal cord was visible but 2.5 mm sized tube could not be advanced,so we used the guide wire which is used for central line, then we could intubate with some resistance. Tracheostomy was not allowed due to diffuse tracheal stenosis reaching from cricoid cartilage to carina. During the extra corporial circulation, the guide wire was inserted from operation field, and 3.5 mm sized tube was introduced via guide wire by anesthesiologist. After operation the grannulation tissue that obstructing airway, was noticed by bronchoscopy, and was removed, then he was weaned from ventilator successfully. The second case was discovered due to diffcult weaning from ventilator after open heart surgery. the bronchogrm showed right tracheal bronchus and diffuse tracheal stenosis from T2 to carina. He was ventilated initially with 4.0 mm sized endotracheal tube, and ventilated intermittently with other 2.5 mm sized endotracheal tube from operation field during tracheal anastomosis. After operation, he died with increased airway pressure and airway bleeding.