儿童滑动式气管成形术的长期结局：227例患者的机构回顾
Long-Term Outcomes of Children Undergoing the Slide Tracheoplasty: An Institutional Review of 227 Patients.
作者
作者单位
- The Heart Institute, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
- Division of Pulmonary Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
- Division of Pediatric Otolaryngology-Head and Neck Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
- Department of Cardiovascular and Thoracic Surgery, UT Southwestern Medical Center, Dallas, Texas; Heart Center at Children's Health, Dallas, Texas. Electronic address: David.Lehenbauer@UTSouthwestern.edu.
摘要
中文
关于滑动式气管成形术（STP）的文献主要局限于小型机构经验。因此，作者分析了其大型机构的STP经验。回顾性分析了2001年至2023年间在该机构接受体外循环（CPB）或体外膜氧合（ECMO）支持下胸段STP的所有连续患者。共纳入227例患者，其中120例（53%）为婴儿，122例（54%）合并先天性心脏病（CHD）。32例（14%）患者为单功能性肺（SFL）。术前，44例（19%）患者接受过≥1次心脏手术，34例（15%）曾在外院行气管成形术需翻修。48例（21%）患者在STP术前已行气管插管。术中，212例（93%）患者接受CPB灌注（15例STP在ECMO下进行），78例（34%）患者同期行心脏修复。术后，94例（42%）患者早期拔管（≤24小时）。院内并发症包括气管裂开（5%，n=12）和气道感染（23%，n=53）。再干预包括再次插管（19%，n=44）、气管内支架（ETS）放置（8%，n=18）、气管切开依赖（5%，n=11）和新发ECMO插管（4%，n=10）。5年及10年免于气管成形术翻修率分别为95%和91%。多变量回归显示，与术后死亡率显著相关（p<0.05）的因素包括：SFL（HR=5.14，CI=1.73-15.29，p=0.003）、CHD（HR=4.34，CI=1.45-12.93，p=0.009）、术后ETS放置（HR=3.79，CI=1.21-11.87，p=0.022）、术后气管切开依赖（HR=9.54，CI=2.86-31.81，p<0.001）、术后气管裂开（HR=6.48，CI=1.17-35.81，p=0.032）、STP术前至术后ECMO（HR=6.39，CI=1.44-28.31，p=0.015）和新发术后ECMO（HR=20.70，CI=5.22-82.09，p<0.001）。总体而言，院内、5年和10年生存率分别为93%、88%和86%。气管畸形呈现复杂的生理状态，关于结局和相关围手术期因素的报道有限。本系列是美国迄今为止最大的机构经验，证明滑动式气管成形术后可获得良好的长期结局。
English
Literature on the slide tracheoplasty-(STP) is primarily limited to small institutional experiences. Therefore, the authors analyzed their large institutional experience of STP. All consecutive patients who underwent thoracic STP on cardiopulmonary bypass-(CPB) or extracorporeal membrane oxygenation-(ECMO) at the authors' institution 2001-2023 were retrospectively reviewed. Two-hundred twenty-seven patients, including 120-(53%) infants and 122-(54%) with congenital heart disease-(CHD), were identified. Thirty-two-(14%) patients had a single functional lung-(SFL). Preoperatively, 44-(19%) patients underwent ≥1 cardiac surgery and 34-(15%) had prior tracheoplasties at outside hospitals requiring revision. Forty-eight-(21%) patients were intubated pre-STP. Intraoperatively, 212-(93%) patients underwent CPB perfusion-(15 STPs were performed on ECMO), and 78-(34%) patients underwent concomitant cardiac repair. Postoperatively, 94-(42%) patients were extubated early-(≤24 hours). In-hospital complications included tracheal dehiscence-(5%, n=12) and airway infection-(23%, n=53). Reinterventions included reintubation-(19%, n=44), endotracheal stent-(ETS) placement-(8%, n=18), tracheostomy dependence-(5%, n=11), and novel ECMO cannulation-(4%, n=10). The 5- and 10-year freedoms from tracheoplasty revision were 95% and 91%, respectively. Upon multivariable regression, factors significantly-(p<0.05) associated with postoperative mortality included: SFL-(HR=5.14, CI=1.73-15.29, p=0.003), CHD-(HR=4.34, CI=1.45-12.93, p=0.009), postoperative ETS placement-(HR=3.79, CI=1.21-11.87, p=0.022), postoperative tracheostomy dependence-(HR=9.54, CI=2.86-31.81, p<0.001), postoperative tracheal dehiscence-(HR=6.48, CI=1.17-35.81, p=0.032), ECMO pre- through post-STP-(HR=6.39, CI=1.44-28.31, p=0.015), and novel postoperative ECMO-(HR=20.70, CI=5.22-82.09, p<0.001). Overall, the in-hospital, 5-, and 10-year survivals were 93%, 88%, and 86%, respectively. Tracheal anomalies present a complex physiologic state with limited reports on outcomes and associated perioperative factors. The present series, the largest institutional experience in the United States to date, demonstrates that excellent long-term outcomes following slide tracheoplasty are achievable.
分类与指标
- 研究类型
- 临床研究
- 病种
- 气管疾病
- JCR 分区
- Q1
- 影响因子
- 4.7