CAJ | 학술논문

目的总结小儿主动脉缩窄和/或主动脉弓发育不良并心内畸形的手术治疗经验.方法回顾性研究2010年1月至2013年6月武汉市儿童医院心胸外科51例主动脉缩窄和/或主动脉弓发育不良患儿临床资料.所有患儿经正中切口行缩窄或弓发育不良并心内畸形矫治术,其中32列行扩大端-端吻合术,19例行端-侧吻合术,术中酌情采取自体心包补片、牛心包补片或自体肺动脉补片扩大吻合口.结果术中出现低心排出量死亡2例.术后死亡2例患儿,1例为术后长期呼吸机辅助无法脱呼吸机,1例术后出现低心排出量.3例术后出现声嘶,随访3个月后基本恢复.47例患儿术后随访2个月～3年,3例患儿出现吻合口缩窄,上下压差偏大[＞20 mmHg(1 mmHg =0.133 kPa)],其中1例拟近期行二次手手术,另外2例随访中.余44例患儿均未出现明显冉狭窄.47例存活患儿均无神经系统并发症.结论小儿主动脉缩窄和/或主动脉弓发育不良并心内畸形应积极诊断,严格把握手术指征,术中酌情采取选择性顺行脑灌注或深低温停循环技术,扩大端-端吻合术和端-侧吻合术均可取得良好的手术效果.
목적 총결소인주동맥축착화/혹주동맥궁발육불량병심내기형적수술치료경험.방법 회고성연구2010년1월지2013년6월무한시인동의원심흉외과51례주동맥축착화/혹주동맥궁발육불량환인림상자료.소유환인경정중절구행축착혹궁발육불량병심내기형교치술,기중32렬행확대단-단문합술,19례행단-측문합술,술중작정채취자체심포보편、우심포보편혹자체폐동맥보편확대문합구.결과 술중출현저심배출량사망2례.술후사망2례환인,1례위술후장기호흡궤보조무법탈호흡궤,1례술후출현저심배출량.3례술후출현성시,수방3개월후기본회복.47례환인술후수방2개월～3년,3례환인출현문합구축착,상하압차편대[＞20 mmHg(1 mmHg =0.133 kPa)],기중1례의근기행이차수수술,령외2례수방중.여44례환인균미출현명현염협착.47례존활환인균무신경계통병발증.결론 소인주동맥축착화/혹주동맥궁발육불량병심내기형응적겁진단,엄격파악수술지정,술중작정채취선택성순행뇌관주혹심저온정순배기술,확대단-단문합술화단-측문합술균가취득량호적수술효과.
Objective To summarize the experiences of surgical treatment for aortic coarctation and/or aortic hypoplasty associated with intracardiac anomalies in infants.Methods The clinical data of 51 cases with aortic coarctation and/or aortic hypoplasty hospitalized in Wuhan Children's Hospital between Jan.2010 and Jun.2013 were analyzed retrospectively.Thirty-two patients had received a expanded end-to-end anastomosis and 19 patients had got a end-to-side anastomosis.Autologous pericardial patch,bovine pericardial patch or autologous pulmonary patch was taken according to the circumstances during surgery.Results There were 2 intraoperative deaths because of serious low cardiac output syndrome,and 2 postoperative deaths,which could not take off long-term respiratory assistance after surgery in aortic one child and low cardiac output syndrome in the other.Three patients appeared trachyphonia but recovered basically after 3 months follow-up.Forty-seven patients were followed up for 2 months-3 years,among them,3 patients had significant upper to lower extremity systolic blood pressure gradient[＞20 mmHg(1 mmHg =0.133 kPa)],and a second operation was proposed recently for 1 of them,while the other 2 children were in follow-up.The other 44 patients did not appear obvious restenosis.The 47 cases of children had no neurologic symptoms.Conclusions There have to be positive diagnoses and strictly surgery indications for aortic coarctation and/or hypoplasty associated with intracardiac anomalies in infants.Selective antegrade cerebral perfusion or deep hypothemic circulatory arrest depends on the surgon's discretion.Both expanded end-to-end anastomosis and end-to-side anastomosis can achieve good operation effects.