儿童先天性完全性气管环的临床及诊治特点

摘要

目的 探讨儿童先天性完全性气管环(CCTR)的临床及诊治特点.方法 2008年1月-2009年12月628例支气管镜检查患儿中诊断CCTR 18例,随访7～27个月,对其临床特点、影像学表现、镜下特征、治疗及转1月进行综合分析.结果 18例中15例表现为反复咳喘,1例为气管插管困难,2例为术后撤机困难.CCTR多位于气管的中下部,合并支气管桥畸形时CCTR位于左主支气管.所有病例均经支气管镜检查确诊.治疗及转归:4例行气管成形术,3例死亡,1例预后好;3例行球囊扩张术,2例术后喘息改善;11例末对CCTR进行处理,6例预后好,2例仍反复喘息,3例死亡.结论 CCTR多表现为反复咳喘.支气管镜是诊断CCTR的金标准,对球囊扩张术有部分治疗作用,需根据临床情况选择适当的治疗方式及手术时机.%Objective To explore the clinical features, diagnostic criteria and treatment of congenital complete tracheal rings ( CCTR ) in children.Methods Among 628 patients examined by bronchoscopy from Jan 2008 to Dec 2009, 18 cases were confirmed to have CCTR.They were observed for two to twenty-seven months and their clinical characteristics, examinations, airway lesion, treatment and prognosis were collected and analyzed.Results Fifteen cases had recurrent or prolonged wheezing and dyspnea, 1 case failed intubation, 2 cases depended on mechanical ventilation after operation.Most tracheal stenosis segments involved in the middle and/or lower part of the tracheal and the left main bronchus were involved when bronchial bridge existed.All patients were diagnosed by bronchoscopy.Four cases underwent repair of tracheoplasty, 1 was good and 3 died.Balloon dilation was used in 3 patients, the condition of 2 were improved.Among 11 patients who haven't been treated for CCTR, 6 had good outcome, 2 had persistent or worsening symptoms and 3 died.Conclusions Most cases of CCTR had wheezing and dyspnea.Bronchoscopy should be regarded as a "golden standard" method for diagnosing CCTR.Balloon dilation had partial therapeutic effect on CCTR.Appropriate treatment and operation time should be considered according to patients' clinical features.