Objective: To examine the outcomes of Slide tracheoplasty for the children with severe congenital tracheal stenosis received previous repeated balloon dilatation or metal stent placement under endoscopy. Methods: A retrospective study was conducted in 9 children with congenital tracheal stenosis undergoing previous interventional therapy under tracheoscopy and later received Slide tracheoplasty due to obvious respiratory symptoms at Department of Cardiac Surgery, Qilu Children's Hospital of Shandong University between February 2017 and July 2021. There were 7 males and 2 females with a median age at operation of 72.4 months (range: 13.3 to 98.9 months), and the median weight was 19.0 kg (range: 9.0 to 33.0 kg). Among the 9 patients, 2 patients began to receive repeated balloon dilatation (more than 3 times) 17.8 and 51.8 months ago respectively. One patient received metal stents placement into the trachea for 4 days and the other 6 children for median 56.8 months (range: 21.6 to 74.2 months). Complete tracheal cartilage rings and long segmental stenosis were present. in all 9 children. Operative details and outcome measures, including the need for endoscopic airway intervention and mortality, were collected. Results: Slide tracheoplasty was performed in all cases. Two patients with repeated balloon dilatation had different thickness of tracheal wall, local scar hyperplasia and irregular lumen. Among them, 1 case had obvious local calcification of tracheal wall, which was difficult to suture. The metal stent in one patient with short time of placement was completely removed. However, only part of the metal stents could be removed due to the long placement time in the other 6 cases. There was no operative death in the 9 children. The median postoperative tracheal intubation time was 25.3 hours (range: 17.4 to 74.5 hours). A silicone stent was placed in the trachea of 1 child due to obvious respiratory symptoms. Follow-up of median 11 months (range: 1 to 23 months) showed that no death occurred after discharge and all children had basically normal activity tolerance with no obvious respiratory symptoms. Conclusions: Slide tracheoplasty is feasible for children undergoing prior balloon dilatation or metal stents placement. Previously repeated balloon dilatation or metal stent placement under endoscopy increased the difficulty of slide tracheoplasty, the metal stent could not be completely removed after a long time.
目的： 探讨对曾接受反复球囊扩张或金属支架置入的先天性气管严重狭窄患儿行手术治疗的经验。 方法： 回顾性分析9例曾接受反复球囊扩张（>3次）或气管内置入金属支架治疗，后因狭窄症状明显于2017年2月至2021年7月在山东大学齐鲁儿童医院心脏外科接受手术治疗的先天性气管狭窄患儿的临床资料。男7例，女2例。中位手术年龄72.4个月（范围：13.3~98.9个月），中位体重19.0 kg（范围：9.0~33.0 kg）。9例患儿均有完全性气管软骨环及长段狭窄。2例患儿分别在本次手术17.8、51.8个月前开始接受反复球囊扩张（均>3次）；7例患儿曾接受金属支架置入，距首次置入金属支架时间1例患儿为4 d，另6例患儿中位时间为56.8个月（范围：21.6~74.2个月）。9例患儿均行Slide气管成形术。 结果： Slide气管成形术均顺利完成。2例反复球囊扩张患儿，术中见气管壁厚薄不一、局部瘢痕增生、管腔不规则，其中1例气管壁局部明显钙化，缝合难度较大。7例支架置入患儿，1例因支架置入时间短，完整取出支架，其余6例因支架置入时间长仅能取出部分金属支架。本组患儿无手术死亡，术后中位气管插管时间25.3 h（范围：17.4~74.5 h）。1例患儿术后因症状明显放置硅酮支架。术后中位随访时间11个月（范围：1~23个月），所有患儿均无明显呼吸道症状，活动耐力基本正常。 结论： 先天性气管狭窄介入治疗后Slide成形术可行。但反复球囊扩张会增加手术难度，金属支架不能完全取出可导致异物残留。.