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中华胸部外科电子杂志 ›› 2020, Vol. 07 ›› Issue (03) : 186 -190. doi: 10.3877/cma.j.issn.2095-8773.2020.03.09

所属专题: 文献

综述

气管支气管软化症的治疗与进展
刘宇健1, 郑开福1, 唐希阳1, 姜涛1, 李小飞1, 赵晋波1,()   
  1. 1. 710032 西安,空军军医大学第二附属医院胸腔外科
  • 收稿日期:2020-08-06 修回日期:2020-08-26 接受日期:2020-08-27 出版日期:2020-08-28
  • 通信作者: 赵晋波
  • 基金资助:
    陕西省创新能力支撑计划(S2018-ZC-XXXM-0054); 空军军医大学第二附属医院医院尖子人才资助基金(2019); 空军军医大学第二附属医院科技创新发展基金(2019QYTS004)

Treatment and progress of tracheobronchomalacia

Yujian Liu1, Kaifu Zheng1, Xiyang Tang1, Tao Jiang1, Xiaofei Li1, Jinbo Zhao1,()   

  1. 1. Department of Thoracic Surgery, Second Affiliated Hospital of Air Force Military Medical University, Xi’an 710032, China
  • Received:2020-08-06 Revised:2020-08-26 Accepted:2020-08-27 Published:2020-08-28
  • Corresponding author: Jinbo Zhao
  • About author:
    Corresponding author: Zhao Jinbo, Email:
引用本文:

刘宇健, 郑开福, 唐希阳, 姜涛, 李小飞, 赵晋波. 气管支气管软化症的治疗与进展[J]. 中华胸部外科电子杂志, 2020, 07(03): 186-190.

Yujian Liu, Kaifu Zheng, Xiyang Tang, Tao Jiang, Xiaofei Li, Jinbo Zhao. Treatment and progress of tracheobronchomalacia[J]. Chinese Journal of Thoracic Surgery(Electronic Edition), 2020, 07(03): 186-190.

气管支气管软化症是一种因气管软骨受损或膜部气管纵行弹性纤维病变引起的气道管壁软弱的疾病。目前临床常见的治疗有保守治疗、持续气道正压通气、气管切开术、气管切除术、气管成形术及气管外支架固定等。每一种治疗方式都有各自的适应证和缺点。随着新兴治疗方式的运用和材料领域的发展,患者的治疗手段得到优化,治疗效果得以提升,但依然存在很多有待解决的问题。

Tracheobronchiomalacia is a disease in which the airway wall is weak due to damage to the cartilage of the trachea or the longitudinal elastic fibrosis of the trachea. At present, the common clinical treatments include conservative treatment, continuous positive airway pressure, tracheotomy, tracheostomy, tracheoplasty, and extratracheal stent fixation. Each treatment has its own indications and shortcomings. With the application of emerging treatment methods and the development of materials, the treatment methods of patients have been optimized and the treatment effect has been improved, but there are still many problems to be solved.

表1 常见治疗手段对比
治疗手段 保守治疗 CPAP 气道内支架植入 外科治疗
气管切开术 气管切除术 气道成形术 气管外支架固定
适应证 1.患者无临床症状;2.轻、中症的2岁以下患儿 中、重症患者的初步治疗、短期治疗或其他治疗的辅助 保守治疗无效的重度气管软化患者 1.当急性气道阻塞时作为急救处理;2.短期治缓解症状,用于建立人工气道 气管软化的节段长度对于成人小于气管全长的1/2,对于儿童小于气管全长的1/3 用于治疗不能直接进行气管内部扩张的长段严重气管软化症 同"气道内支架植入",即保守治疗无效的重度气管软化患者
优点 无需有创干预,持续观察即可 降低患者呼气阻力,使患者气道开放并增大呼气气流,在急性期使用可预防肺不张 可直接扩张气管支气管,患者无需开胸,操作时间短,创伤小 操作简单,可快速解除气管狭窄引起的严重呼吸困难 可直接解决气道局部疾病,并不引起免疫排斥反应,是目前临床上气管重建最有效的方法 1.在一定程度上保留原有的气管组织;2.特别适用于因膜部气管引起的重症气管软化症患者 不改变气道的黏膜纤毛结构,气道阻塞等并发症少,相比"气道内支架植入"更适合儿童患者
缺点 目前无特效药物,一般患者服用支气管扩张剂还可加重病情 不能用于儿童TBM的长期治疗,也不能作为重度TBM的独立治疗方式 易产生肉芽组织增生、支架移位、影响正常气管上皮功能,甚至穿透气管壁引起严重并发症 并发症过多,如拔管困难、气管痉挛狭窄、气管损伤、继发性气管软化、呼吸道反复感染等 1.不适合于大段气管切除或气管缺损的治疗。若气管切除过长,术中无法行一期吻合;2.气管长段切除术后吻合张力大,术后易发生吻合口狭窄 1.手术过程相对复杂;2.有伤口感染和裂开等并发症,有一定的术后再狭窄风险;3.对于远端支气管软化的治疗有限 1.临床上使用较少,可行性和安全性未得到验证;2.由于需个性化制订,外支架难以量化和批量生产
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