中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2014年
7期
535-539
,共5页
何岚%吴琳%刘芳%齐春华%陆颖%张丹艳%黄国英
何嵐%吳琳%劉芳%齊春華%陸穎%張丹豔%黃國英
하람%오림%류방%제춘화%륙영%장단염%황국영
主动脉缩窄%儿童%球囊扩张成形术
主動脈縮窄%兒童%毬囊擴張成形術
주동맥축착%인동%구낭확장성형술
Aortic coarctation%Child%Balloon angioplasty
目的 评价球囊扩张成形术治疗不同年龄儿童先天性主动脉缩窄的效果与安全性.方法 回顾性分析2006年1月至2012年12月收治的37例未经治疗的局限性主动脉缩窄患儿在复旦大学附属儿科医院实施球囊扩张成形术的临床资料.37例患儿中男26例、女11例;中位年龄10个月(7d～6岁);体重6.3 (2.5～17.0) kg.术后随访1年,包括穿刺部位的动脉搏动、缩窄部位的再狭窄以及动脉瘤的形成,并对手术时年龄≤3个月和＞3个月的患儿进行比较.组间比较采用t检验或Fisher精确检验.结果 球囊扩张成形术在37例患儿中均获得了成功,术后即刻测量,缩窄两端收缩期峰值压差降至＜20 mmHg(1 mmHg =0.133 kPa).手术时年龄≤3个月组25例与＞3个月组12例患儿术前的主动脉缩窄两端收缩期峰值压差差异无统计学意义[收缩期最大压差(51±21)比(61±16) mmHg,收缩期平均压差(31±11)比(40±13) mmHg,均P＞0.05];术后跨缩窄前后的压差分别由术前(38±18)和(47±18) mmHg降至(12±11)和(17±12)mmHg(均P＜0.01),缩窄段直径由(1.8±0.7)和(2.6±1.5)mm增至(3.7±1.1)和(5.5±1.8)mm(均P＜0.01).32例(86.5％)患儿完成了术后为期1年的随访,其中3例(9.4％)出现术后穿刺部位动脉损伤,均发生在≤3个月组(P =0.537);8例(25.0％)术后发生主动脉缩窄部位再狭窄,其中≤3个月组6例,＞3个月组2例,两组之间再狭窄发生率差异无统计学意义(P=1.000).2例(5.4％)患儿术后即刻在扩张部位出现小型动脉瘤,其中≤3个月组和＞3个月组各1例(12/25比1/12,P=0.755).17例患儿在术后1年进行了计算机断层摄影血管造影或磁共振血管造影检查,未发现远期新的动脉瘤形成.结论 对于儿童局限性主动脉缩窄,球囊扩张成形术近期疗效佳,安全性高,其中手术时年龄≤3个月与＞3个月组患儿的术后穿刺动脉损伤、缩窄部位的再狭窄以及动脉瘤的形成的发生率无差异.
目的 評價毬囊擴張成形術治療不同年齡兒童先天性主動脈縮窄的效果與安全性.方法 迴顧性分析2006年1月至2012年12月收治的37例未經治療的跼限性主動脈縮窄患兒在複旦大學附屬兒科醫院實施毬囊擴張成形術的臨床資料.37例患兒中男26例、女11例;中位年齡10箇月(7d～6歲);體重6.3 (2.5～17.0) kg.術後隨訪1年,包括穿刺部位的動脈搏動、縮窄部位的再狹窄以及動脈瘤的形成,併對手術時年齡≤3箇月和＞3箇月的患兒進行比較.組間比較採用t檢驗或Fisher精確檢驗.結果 毬囊擴張成形術在37例患兒中均穫得瞭成功,術後即刻測量,縮窄兩耑收縮期峰值壓差降至＜20 mmHg(1 mmHg =0.133 kPa).手術時年齡≤3箇月組25例與＞3箇月組12例患兒術前的主動脈縮窄兩耑收縮期峰值壓差差異無統計學意義[收縮期最大壓差(51±21)比(61±16) mmHg,收縮期平均壓差(31±11)比(40±13) mmHg,均P＞0.05];術後跨縮窄前後的壓差分彆由術前(38±18)和(47±18) mmHg降至(12±11)和(17±12)mmHg(均P＜0.01),縮窄段直徑由(1.8±0.7)和(2.6±1.5)mm增至(3.7±1.1)和(5.5±1.8)mm(均P＜0.01).32例(86.5％)患兒完成瞭術後為期1年的隨訪,其中3例(9.4％)齣現術後穿刺部位動脈損傷,均髮生在≤3箇月組(P =0.537);8例(25.0％)術後髮生主動脈縮窄部位再狹窄,其中≤3箇月組6例,＞3箇月組2例,兩組之間再狹窄髮生率差異無統計學意義(P=1.000).2例(5.4％)患兒術後即刻在擴張部位齣現小型動脈瘤,其中≤3箇月組和＞3箇月組各1例(12/25比1/12,P=0.755).17例患兒在術後1年進行瞭計算機斷層攝影血管造影或磁共振血管造影檢查,未髮現遠期新的動脈瘤形成.結論 對于兒童跼限性主動脈縮窄,毬囊擴張成形術近期療效佳,安全性高,其中手術時年齡≤3箇月與＞3箇月組患兒的術後穿刺動脈損傷、縮窄部位的再狹窄以及動脈瘤的形成的髮生率無差異.
목적 평개구낭확장성형술치료불동년령인동선천성주동맥축착적효과여안전성.방법 회고성분석2006년1월지2012년12월수치적37례미경치료적국한성주동맥축착환인재복단대학부속인과의원실시구낭확장성형술적림상자료.37례환인중남26례、녀11례;중위년령10개월(7d～6세);체중6.3 (2.5～17.0) kg.술후수방1년,포괄천자부위적동맥박동、축착부위적재협착이급동맥류적형성,병대수술시년령≤3개월화＞3개월적환인진행비교.조간비교채용t검험혹Fisher정학검험.결과 구낭확장성형술재37례환인중균획득료성공,술후즉각측량,축착량단수축기봉치압차강지＜20 mmHg(1 mmHg =0.133 kPa).수술시년령≤3개월조25례여＞3개월조12례환인술전적주동맥축착량단수축기봉치압차차이무통계학의의[수축기최대압차(51±21)비(61±16) mmHg,수축기평균압차(31±11)비(40±13) mmHg,균P＞0.05];술후과축착전후적압차분별유술전(38±18)화(47±18) mmHg강지(12±11)화(17±12)mmHg(균P＜0.01),축착단직경유(1.8±0.7)화(2.6±1.5)mm증지(3.7±1.1)화(5.5±1.8)mm(균P＜0.01).32례(86.5％)환인완성료술후위기1년적수방,기중3례(9.4％)출현술후천자부위동맥손상,균발생재≤3개월조(P =0.537);8례(25.0％)술후발생주동맥축착부위재협착,기중≤3개월조6례,＞3개월조2례,량조지간재협착발생솔차이무통계학의의(P=1.000).2례(5.4％)환인술후즉각재확장부위출현소형동맥류,기중≤3개월조화＞3개월조각1례(12/25비1/12,P=0.755).17례환인재술후1년진행료계산궤단층섭영혈관조영혹자공진혈관조영검사,미발현원기신적동맥류형성.결론 대우인동국한성주동맥축착,구낭확장성형술근기료효가,안전성고,기중수술시년령≤3개월여＞3개월조환인적술후천자동맥손상、축착부위적재협착이급동맥류적형성적발생솔무차이.
Objective Balloon angioplasty is an alternative to surgical repair for coarctation of the aorta in children.However,its role in the treatment of neonates and infants younger than 3 months old remains controversial.The purpose of this study was to evaluate the efficacy and safety of balloon angioplasty for native coarctation by comparing children in different age groups.Method This is a retrospective clinical study including 37 children treated with balloon angioplasty for native coarctation from January 2006 to December 2012.A total of 37 patients consisting of 26 boys and 11 girls underwent the procedure,with median age 10 months (range from 7 days to 6 years) and the mean body weight was 6.3 (2.5-17.0) kg.The indication of the procedure includes discrete native coarctation without aortic arch hypoplasia and a peak-to-peak systolic pressure gradient ＞ 20 mmHg (1 mmHg =0.133 kPa) across aortic coarctation.During one year follow-up,the approach artery injury,recoarctation and aneurysm formation were particularly assessed.Result We classified these patients into two groups according to their age.Group A consisted of 25 patients younger than 3 months and Group B of 12 patients older than 3 months.There was no significant difference between the two groups in systolic pressure gradient before balloon angioplasty (P ＞ 0.05).The mean peak systolic gradient decreased from (38 ± 18) mmHg to (12 ± 11) mmHg immediately after angioplasty in group A and from (47 ±18) to (17 ± 12) mmHg in group B (P =0.000 for both).Meanwhile,the mean diameter of the coarctation segment increased from (1.8 ± 0.7) to (3.7 ± 1.1) mm after angioplasty in group A and from (2.6 ± 1.5) to (5.5 ± 1.8) mm in group B (both P =0).The initial successful balloon angioplasty (immediate postangioplasty peak pressure gradient ＜ 20 mmHg) was achieved in all the 37 patients; 32 patients (86.5％) have been followed up for one year.Approach arterial complications occurred in 3 patients (9.4％),all of whom were in Group A (P =0.537).Two patients had decreased femoral artery pulse and one required surgical repair for a postoperative pseudoaneurysm at left carotid artery.At follow-up,8 patients (25.0％) developed recoarctation,with 6 cases in Group A and 2 in Group B.There was no significant difference between groups A and B in the recoarctation rate (P =1.000).Among them,7 patients underwent repeat balloon angioplasty,and all showed successful relief of coarctation,and one patient required surgical repair.Two patients (2/37,5.4％) had small aneurysms of the descending aorta immediately after balloon angioplasty,with one patient in each group (12/25 vs.1/12,P =0.755).Late aneurysm development has not been observed in the 17 patients who have had a follow-up CTA or MRA study.Conclusion Balloon angioplasty of discrete native coarctation is effective and safe in children both younger and older than 3 months with similar incidence of approach arterial complication,recoarctation and aneurysm formation.
