Pädiatrische Atemwegschirurgie: Indikationen und Techniken

Zusammenfassung

In der pädiatrischen Atemwegschirurgie sind zahlreiche anatomische Besonderheiten, spezifische Krankheitsbilder sowie spezielle Operationstechniken zu beachten. Auch an spezialisierten Zentren sind diese Eingriffe bei pädiatrischen Patienten eher selten. Ätiologisch handelt es sich meist um erworbene Stenosen als Folge von Frühgeburtlichkeit, Langzeitintubation oder -tracheotomie, welche typischerweise in Kindern mit zahlreichen Komorbiditäten auftreten. Kongenitale Fehlbildungen der Atemwege gehen häufig mit weiteren Malformationen einher, welche die erfolgreiche Behandlung zusätzlich erschweren. Voraussetzung zur Behandlung dieser Kinder sollte daher ein multidisziplinäres Team sein. An erfahrenen Zentren mit entsprechender Infrastruktur kann die chirurgische Behandlung dieser Kinder mit sehr guten Ergebnissen durchgeführt werden. So wird bei den meisten Patienten nach chirurgischer Behandlung eine sehr gute Lebensqualität ohne Notwendigkeit einer Langzeittracheostomie erreicht. Diese Übersichtsarbeit fasst die wichtigsten Indikationen, sowie die häufigsten Operationstechniken in der pädiatrischen Atemwegschirurgie zusammen.

Abstract

Even in specialised centres, surgical procedures on the airway are only rarely performed in paediatric patients. Moreover, knowledge of various specific anatomical characteristics, diseases and surgical techniques is a prerequisite to treat these patients. Most commonly, sequelae of long-term intubation or tracheostomy in multimorbid patients necessitate surgical repair. Moreover, congenital malformations of the airways might require surgical interventions. However, these are commonly associated with other organ malformations, which adds further complexity to the treatment concept. Thus, cooperation within an interdisciplinary team is absolutely necessary to treat these patients. However, good postoperative outcomes after paediatric airway surgery can be achieved in experienced centres with an appropriate infrastructure. Specifically, this means long-term tracheostomy-free survival with preserved laryngeal functions in most of the patients. This review provides a summary of common indications and surgical techniques in paediatric airway surgery.

Schlüsselwörter

Trachealstenose - Subglottische Stenose - Laryngotracheale Rekonstruktion

Keywords

tracheal stenosis - subglottic stenosis - laryngotracheal reconstruction

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