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首页> 外文期刊>The Laryngoscope: A Medical Journal for Clinical and Research Contributions in Otolaryngology, Head and Neck Medicine and Surgery, Facial Plastic and Reconstructive Surgery .. >Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy
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Innovative management of severe tracheobronchomalacia using anterior and posterior tracheobronchopexy

机译：使用前后气管支气管的严重气管划分的创新管理

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Objectives/Hypothesis Combined anterior and posterior tracheobronchopexy is a novel surgical approach for the management of severe tracheobronchomalacia (TBM). We present our institutional experience with this procedure. Our objective was to determine the utility and safety of anterior and posterior tracheopexy in the treatment of severe TBM. Study Design Retrospective chart review. Methods All patients who underwent anterior and posterior tracheopexy from January 2013 to July 2017 were retrospectively reviewed. Charts were reviewed for indications, preoperative work‐up, tracheobronchomalacia classification and severity, procedure, associated syndromes, synchronous upper aerodigestive tract lesions, and aberrant thoracic vessels. Main outcomes measured included improvement in respiratory symptoms, successful extubation and/or decannulation, vocal fold immobility, and new tracheotomy placement. Results Twenty‐five patients underwent anterior and posterior tracheopexy at a mean age of 15.8?months (range, 2–209?months; mean, 31?months if 2 outliers of 206 and 209?months included). Mean length of follow‐up was 26.8?months (range, 13–52?months). Indications for surgery included apneic events, ventilator dependence, need for positive pressure ventilation, tracheotomy dependence secondary to TBM, recurrent pneumonia, and exercise intolerance. Many patients had other underlying syndromes and synchronous upper aerodigestive tract lesions (8 VACTERL, 2 CHARGE, 1 trisomy 21, 1 Feingold syndrome, 17 esophageal atresia/tracheoesophageal fistula, 20 cardiac/great vessel anomalies, 1 subglottic stenosis, 1 laryngomalacia, 7 laryngeal cleft). At preoperative bronchoscopy, 21 of 25 patients had 90% collapse of at least one segment of their trachea, and the remaining four had 70% to 90% collapse. Following anterior and posterior tracheopexy, one patient developed new bilateral vocal‐fold immobility; one patient with a preoperative left cord paralysis had a new right vocal‐fold immobility. Postoperatively, most patients had significant improvement in their respiratory symptoms (21 of 25, 84%) at most recent follow‐up. Three patients with preexisting tracheotomy were decannulated; two patients still had a tracheotomy at last follow‐up. Two patients required new tracheotomy for bilateral vocal‐fold immobility. Conclusions Combined anterior and posterior tracheopexy is a promising new technique for the surgical management of severe TBM. Further experience and longer follow‐up are needed to validate this contemporary approach and to minimize the risk of recurrent laryngeal nerve injury. Level of Evidence 4 Laryngoscope , 130:E65–E74, 2020
机译：目标/假设联合前和后轮气管螺旋己酮是一种新的手术方法，用于治疗严重的气管支气管（TBM）。我们介绍了我们这个程序的机构经验。我们的目的是确定前躯干气管盆中的效用和安全性治疗严重TBM。研究设计回顾性图表评论。方法回顾性审查从2013年1月到2017年7月到2017年7月接受前后气管盆的所有患者。审查了迹象，术前锻炼，气管支气管癌分类和严重程度，程序，相关综合征，同步上部气体血管血管病变和异常胸腔血管的图表。测量的主要结果包括改善呼吸道症状，成功拔管和/或分裂，声带不动，以及新的气管切开术。结果二十五名患者接受前后气管盆中的平均年龄为15.8？月（范围，2-209个月;平均值，31个月，如果包括206和209个月的2个月）。随访的平均长度为26.8？月（范围，13-52个月）。手术的适应症包括送风事件，呼吸机依赖性，需要正压通风，步气管术依赖于TBM，复发性肺炎和运动不耐受。许多患者患有其他潜在的综合征和同步的上部气质刺激病变（8个细胞，2个电荷，1个三胞癣21,11 Feingold综合征，17个食道闭锁/气管瘘，20例心脏/大血管异常，1个序曲狭窄，1个喉头狭窄，7个喉部裂缝）。在术前支气管镜检查中，21例患者中的21例＆剩余的四个片段崩溃的90％崩溃，剩下的四个有70％至90％的崩溃。前后气管泛症后，一名患者开发了新的双侧声带不动;一名患有术前左脐带麻痹的患者具有新的右声不动。术后，大多数患者在最近的后续随访中对其呼吸系统症状（21例，84％的21％的21％的患者显着改善。三个患有预先存在的气管切开术的患者;两名患者在最后一次随访时仍有气管切开术。两名患者需要新的气管切开术，用于双侧声带不动。结论联合前后气管盆种是严重TBM手术管理的有希望的新技术。需要进一步的经验和更长的后续行动来验证这种现代方法，并尽量减少复发性喉神经损伤的风险。证据水平4喉镜，130：E65-E74,2020

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