中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2009年
5期
272-275
,共4页
主动脉瓣上狭窄,先天性%心脏外科手术
主動脈瓣上狹窄,先天性%心髒外科手術
주동맥판상협착,선천성%심장외과수술
Supravalvular aortic stenosis,congenital%Cardiac surgical procedures
目的 回顾总结儿童先天性主动脉瓣上狭窄(SVAS)的外科治疗经验,提高治疗水平.方法 1990年至2006年10月25例先天性主动脉瓣上狭窄患儿接受手术治疗.其中男16例,女9例,手术平均年龄(5.4±2.4)岁,平均体重(12.6±3.5)kg.影像学检查发现22例为局限性狭窄,主动脉瓣上0.5～2.0 cm处有狭窄段,3例为弥漫性狭窄.平均压力阶差(81.7±21.5)mmHg,William's综合征12例.所有患儿均在体外循环下行补片扩大主动脉成形术,11例以"泪珠"状补片扩大成形修补,14例以"裤衩"状补片扩大加宽主动脉狭窄部.补片材料选择应用自体心包17例,Dacron涤纶补片2例,Gore-tex人工血管补片6例,其中内衬自体心包片1例.对伴发畸形同时加以纠治.结果 术后检查主动脉瓣上流速、压差均明显下降,平均(26.0±13.2)mmHg,住院死亡1例,存活24例.结论 应用"泪珠"状和"裤衩"状补片进行主动脉扩大成形术矫治儿童主动脉瓣上狭窄有效,尤以"裤衩"状补片为首选,婴幼儿补片材料以自体心包为宜.
目的 迴顧總結兒童先天性主動脈瓣上狹窄(SVAS)的外科治療經驗,提高治療水平.方法 1990年至2006年10月25例先天性主動脈瓣上狹窄患兒接受手術治療.其中男16例,女9例,手術平均年齡(5.4±2.4)歲,平均體重(12.6±3.5)kg.影像學檢查髮現22例為跼限性狹窄,主動脈瓣上0.5～2.0 cm處有狹窄段,3例為瀰漫性狹窄.平均壓力階差(81.7±21.5)mmHg,William's綜閤徵12例.所有患兒均在體外循環下行補片擴大主動脈成形術,11例以"淚珠"狀補片擴大成形脩補,14例以"褲衩"狀補片擴大加寬主動脈狹窄部.補片材料選擇應用自體心包17例,Dacron滌綸補片2例,Gore-tex人工血管補片6例,其中內襯自體心包片1例.對伴髮畸形同時加以糾治.結果 術後檢查主動脈瓣上流速、壓差均明顯下降,平均(26.0±13.2)mmHg,住院死亡1例,存活24例.結論 應用"淚珠"狀和"褲衩"狀補片進行主動脈擴大成形術矯治兒童主動脈瓣上狹窄有效,尤以"褲衩"狀補片為首選,嬰幼兒補片材料以自體心包為宜.
목적 회고총결인동선천성주동맥판상협착(SVAS)적외과치료경험,제고치료수평.방법 1990년지2006년10월25례선천성주동맥판상협착환인접수수술치료.기중남16례,녀9례,수술평균년령(5.4±2.4)세,평균체중(12.6±3.5)kg.영상학검사발현22례위국한성협착,주동맥판상0.5～2.0 cm처유협착단,3례위미만성협착.평균압력계차(81.7±21.5)mmHg,William's종합정12례.소유환인균재체외순배하행보편확대주동맥성형술,11례이"루주"상보편확대성형수보,14례이"고차"상보편확대가관주동맥협착부.보편재료선택응용자체심포17례,Dacron조륜보편2례,Gore-tex인공혈관보편6례,기중내츤자체심포편1례.대반발기형동시가이규치.결과 술후검사주동맥판상류속、압차균명현하강,평균(26.0±13.2)mmHg,주원사망1례,존활24례.결론 응용"루주"상화"고차"상보편진행주동맥확대성형술교치인동주동맥판상협착유효,우이"고차"상보편위수선,영유인보편재료이자체심포위의.
Objective To summarize the experience of surgical treatment for patients with congenital supravalvular attic stenosis (SvAS) retrospectively.Methods From1990 to 2006,25 cases (16 boys and 9 girls) underwent surgical correction for congenital SVAS at Shanghai Children's Medical Center,with the mean age of (5.4±2.4) years and mean body weight of (12.6±3.5)kg.Twenty-two cases were diagnosed as SVAS with stenosis at 0.5 to 2.0 cm above the aortic valve,in whom 3 as the diffused type.The mean gradient pressure of SVAS was (81.7±21.5) mmHg.Twelve eases complicated with William's syndrome.Aortoplasty with single teardrop-shaped patch was performed on 11 cases,and aortoplasty with inveged bifurcated patch on 14 cases.Both procedures were performed under extracorporeal circulation.The stuff of patch included autografts of perieardium for 17 cases,Darcon patches for 2 and Gore-tex patches for 6.Results The mean postoperative gradient pressure was (25.96±13.1 8) mmHg,which was significantly lower than mean pre-operative pressure.The mean postoperative supra-valvular flow rate also decreased significantly.Total mortality during hospitalization was 4%,since one patient died due to postoperative heart failure,while the other 24 survived.Conclusions The aortoplasty with single teardrop-shaped or inverted bifurcated patches is an effective procedure for children with congenital supra-valvular artic stenosis.The inverted bifurcated patch is the primary alternative of aortoplasty for children,while the autograft of pericardium is the primary alternative for infants with SVAS.
