纤维支气管镜下带囊支架置入术治疗儿童气管狭窄2例

摘要

目的 通过纤维支气管镜下带囊支架置入术治疗儿童气管狭窄,观察近期疗效和并发症.方法 例1,女,4月龄,因"发现心脏杂音3个月余,咳嗽10 d渐加重,伴发热、喘息3 d"入院,诊断为膜周部+肌部室间隔缺损,房间隔缺损(继发孔型),肺动脉高压,主气道下段及左右主支气管变形狭窄.行肺动脉环缩术,房间隔、室间隔缺损修补术+主动脉悬吊术成功后,术后2个月内3次撤离呼吸机均未成功.例2,女,1岁10个月,因"咳嗽1个月余"入院,诊断为左主支气管狭窄,EBV相关性噬血细胞淋巴组织细胞增生症.左侧支气管狭窄致使排痰困难,肺部反复感染,左肺气肿.2例患儿家长在充分了解纤维支气管镜下带囊支架置入术可能的风险后签署知情同意书.采用"边麻边进"方法行气道黏膜表面麻醉,例1和例2 选择带囊支架长度分别为24和29 mm,直径均为4 mm(均经雷帕霉素处理),由支架导入器送入纤维支气管镜,在纤维支气管镜直视下释放带囊支架,然后退出支架导入器.结果 2例患儿置入带囊支架后狭窄段气管扩张良好,带囊支架放置2～3个月随访,未见肉芽组织增生等并发症.结论 纤维支气管镜下带囊支架置入术治疗气管狭窄近期疗效较好,远期疗效尚待观察.%Objective To observe the effectiveness and complications of the halloon dilation expanding metallic airway stent via fiberoptic bronchoscope for treatment of tracheal stenosis.Methods Case 1 , a 4-month-old girl, had severe congenital heart disease with tracheal stenosis.She was extubated three times unsuccessfully after the cardiac surgery in two months.Case 2, a 22month-old girl, had EB virus-associated hemophagocytic lymphoid tissue hyperplasia with left bronchus stenosis.which resulted in repeated lung infections and left emphysema.The agreement about the operation risk was signed by the parent.Balloon expandable stents were inserted into the trachea for the 2 infants.The stents were placed on balloon catheters and inserted into the desired position bronc:hoscopically hy local anesthesia.They were expanded and fixed in the place by inflating the balloon to an appropriate diameter.The stents were 24 and 29 mm in length and 4 mm in diameter.Results Two patients were relieved of airway obstruction after being inserted the stents.No granulation tissue developed over the stents.Stents were in the place for 2 to 3 months after insertion without any other complication.Conclusions Balloon expandable metallic stents can be left for a prolonged period to relieve tracheal obstruction of tracheal stenosis in the near future.but the long-term effect is still needed.