CAJ | 학술논문

目的总结先天血管环畸形的解剖变异及外科治疗经验.方法回顾性分析2009年3月-2012年2月收治的21例先天血管环畸形患儿的临床资料.21例中男10例,女11例;年龄4个月～3岁,平均1.1岁.患儿术前均行心脏超声、64排CT检查,其中双主动脉弓8例、右位主动脉弓伴左侧韧带6例、右位主动脉弓伴迷走左锁骨下动脉2例、肺动脉吊带4例、左位主动脉弓伴右侧动脉导管1例,合并法洛四联症4例、室间隔缺损2例、单心房1例、完全性肺静脉异位引流1例、肺静脉狭窄1例.21例均在全麻下行畸形矫治术,其中低温体外循环下手术矫治12例,非体外循环手术9例(7例采用左后外侧切口,2例采用左腋下切口).结果所有患儿均顺利完成手术.其中体外循环下手术的患儿,体外循环34～83 min,中位数47 min;主动脉阻断19～50 min,中位数26 min.1例患儿术后出现呼吸功能不全,再次插管呼吸机辅助呼吸.所有患儿均康复出院,于出院后1、3、6、12个月复查,此后每年复查1次.21例患儿平均随访3.6年.随访期间患儿呼吸道症状消失或明显缓解,生长发育正常.术后1个月复查胸部CT气管重建示:气管狭窄较前明显改善.结论根据先天血管环的解剖变异及是否合并心内畸形选择相应的外科治疗方案,可取得较好的治疗效果.
목적 총결선천혈관배기형적해부변이급외과치료경험.방법 회고성분석2009년3월-2012년2월수치적21례선천혈관배기형환인적림상자료.21례중남10례,녀11례;년령4개월～3세,평균1.1세.환인술전균행심장초성、64배CT검사,기중쌍주동맥궁8례、우위주동맥궁반좌측인대6례、우위주동맥궁반미주좌쇄골하동맥2례、폐동맥조대4례、좌위주동맥궁반우측동맥도관1례,합병법락사련증4례、실간격결손2례、단심방1례、완전성폐정맥이위인류1례、폐정맥협착1례.21례균재전마하행기형교치술,기중저온체외순배하수술교치12례,비체외순배수술9례(7례채용좌후외측절구,2례채용좌액하절구).결과 소유환인균순리완성수술.기중체외순배하수술적환인,체외순배34～83 min,중위수47 min;주동맥조단19～50 min,중위수26 min.1례환인술후출현호흡공능불전,재차삽관호흡궤보조호흡.소유환인균강복출원,우출원후1、3、6、12개월복사,차후매년복사1차.21례환인평균수방3.6년.수방기간환인호흡도증상소실혹명현완해,생장발육정상.술후1개월복사흉부CT기관중건시:기관협착교전명현개선.결론 근거선천혈관배적해부변이급시부합병심내기형선택상응적외과치료방안,가취득교호적치료효과.
Objective To summarize the anatomical variations and surgical experiences of congenital vascular rings.Methods From Mar.2009 to Feb.2012,21 patients (10 males,11 females)between the ages of 4 months and 3 years (mean:1.1 years) with congenital vascular rings who received surgical treatment in our department were reviewed.Anatomical variations included double aortic arch (8cases),right aortic arch with left ligamentum arteriosum (6 cases),right aortic arch with left subclavian artery (2 cases),pulmonary sling (4 cases),left aortic arch with right ligamentum arteriosum (1 case).Associated anomalies included 4 tetralogy of Fallot,2 ventricular septal defect,1 single atrium,1 total anomalous pulmonary venous connection,1 pulmonary vein stenosis.Twelve cases were performed with the assistance of cardiopulmonary bypass through median sternotomy.Nine cases were performed without cardiopulmonary bypass (7 left thoracic incisions,2 left subaxillary incisions).Results All the patients recovered uneventfully and discharged from hospital after recovery.Follow-up (mean 3.6 years) information showed that the patients had normal growth and development and the respiratory symptoms were relieved.Conclusions Surgical treatment of congenital vascular rings should be performed as soon as possible according to the anatomical variations and associated anomalies of the heart.Excellent clinical results can be achieved after surgery.