主动脉缩窄解剖类型与手术方式选择的临床研究  

Correlative research of aorta coarctation anatomy and surgical approach selected

作　　者：孟兵[1,2] 杨传瑞[1,2] 苏俊武[1,2] 程沛[1,2] 张辉[1,2] 范祥明[1,2] 李志强[1,2] 李晓锋[1,2] 侯嘉[1,2] 刘迎龙[1,2] 

机构地区：[1]首都医科大学附属北京安贞医院 [2]北京市心肺血管疾病研究所小儿心脏中心,北京100029

出　　处：《心肺血管病杂志》2013年第3期321-324,共4页Journal of Cardiovascular and Pulmonary Diseases

摘　　要：目的:探讨不同解剖类型的主动脉缩窄(coarctation of the aorta,CoA)外科手术治疗方法的选择。方法:2005年1月至2012年10月,107例CoA矫治手术,年龄20d～14岁,平均(2.1±3.7)岁,体质量3.5～52kg,平均(10.4±0.8)kg。根据手术方法分为三组,A组:常温下左后外侧剖胸矫治36例。B组:正中剖胸体外循环下矫治62例;采用深低温经无名动脉选择性脑区域灌注(selective cerebralperfusion,SCP)59例,中低温SCP 2例,经主动脉及动脉导管灌注深低温停循环1例。C组:2011年前,联合上述两种剖胸方法矫治9例。结果:全组手术死亡3例(2.8%),死因为全身循环衰竭1例或肺部感染2例,均为B组患儿。迟发出血、III°-AVB并发症各1例。全组上下肢有创血压压差由术前28.6～39.0mmHg(1mmHg=0.133kPa),平均(33.8±2.6)mmHg降至术后12.2～19.9mmHg,平均(16.0±1.9)mmHg。超声证实,术前及术后1w狭窄段压差由平均(44.7±2.2)mmHg降至平均(18.9±1.0)mmHg,三组间均差异无统计学意义(P>0.05)。结论:可根据主动脉缩窄的类型选择手术方法:单纯或合并动脉导管未闭的CoA可选择常温下左后外侧剖胸矫治;合并心内畸形或弓发育不良应正中剖胸深低温SCP下一期矫治;如分步矫治也可取得较好效果,应术前明确诊断,避免漏诊。Objective：To explore how to select surgical procedures for different anatomical type of coarctation of the aorta（CoA）.Methods： From January 2005 to October 2012,107 infants and childrens diagnosed as underwent surgical treatment.The age of the patients was 20d～14 years,mean（2.1±3.7） years.The body weight was 3.5～52 kg,mean（10.4±0.8） kg.All patients were divided into three groups.Group A： 36 cases diagnosed as a simple discrete narrowing of the aortic isthmus or conbine with Patent ductus arteriosus,which were applied to repare aortic coarctation at room temperature under the rear left posterolateral thoracotomy.Group B： 62 cases were applied to repare aortic coarctation at one-stage opration through median sternotomy,selective cerebral perfusion（SCP）was used in 59 cases.Group C：9 cases had staged repair,which were applied to repair aortic coarctation and intracardiac anomaly respectively by left thoractomy and midian sternotomy.Results： There were 3 operative death（2.8%）,which were in the B group.The upper and lower extremities differential pressure of the whole group were dropped from mean（33.8±2.6）mmHg（1mmHg= 0.133kPa） to（16.0±1.9）mmHg.Conclusion： Room temperature left rear lateral incision appliance have satisfactory results in simple discrete narrowing of the aortic isthmus or conbine with patent ductus arteriosus.One-stage repair through median stemotomy can be applied to most of the patients.Staged repair is still a good way for the patients that complicated with intracardiac anomaly.

关 键 词：主动脉缩窄 解剖分型 手术方法 选择性脑区域灌注 

分 类 号：R54[医药卫生—心血管疾病]