先天性広範囲気管狭窄症の一例 : 肋軟骨グラフトの術後変化について

概要

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A six-month old girl was admitted with severe respiratosy distress. Respiratory insufficiency rapidly deteriorated in spite of mechanical ventilation. Tracheoscopy and bronchogram revealed the existence of congenital extensive tracheal stenosis. Tracheoplasty using costal cartilage graft was performed. In the operation, an associated pulmonary artery sling was released before tracheoplasty. Re-stenosis of the trachea occurred near the carina one month after the tracheoplasty. Several attempts to enlarge the stenotic segment, such as removal of the granulation tissue and high pressure pneumatic balloon dilatation, were unsuccessful. The second operation was performed at 6 months after the tracheoplasty. The stenotic segment of the trachea was resected and end to end anastomosis was carried out. Intraoperative massive bleeding was observed from the left pulmonary artery, which had penetrated into the trachea. She expired due to DIC at 8 hours after the operation. Postmortem examination of the cartilage graft revealed, (1) disappearance of cartilage cells and (2) partial replacement by the fibrous tissue. These facts suggested that the graft was in the process of absorption.
日本小児外科学会の論文
1989-10-20