儿童胸骨裂外科矫治4例报道  

Surgical correction of 4 cases with congenital sternal cleft

作　　者：陶麒麟[1] 贾兵[1] 陈张根[1] 叶明[1] 陈纲[1] 

机构地区：[1]复旦大学附属儿科医院心胸外科,上海201102

出　　处：《复旦学报（医学版）》2014年第3期365-368,共4页Fudan University Journal of Medical Sciences

摘　　要：目的 总结外科矫治儿童胸骨裂的临床经验。 方法 2006年12月至2012年10月手术治疗胸骨裂4例,男性2例,女性2例。病例1及病例2为Cantrell五联症,病例3及病例4为单纯性胸骨上裂。病例1及病例2均存在心脏异位,均修补胸骨下裂、腹壁缺损、膈肌缺损及膈面心包缺损。病例1合并小型室间隔缺损未处理,病例2合并肺动脉高压型右室双出口同期矫治。病例1及病例2采用斜行肋软骨切开术延长肋骨后对合胸骨,病例1辅以2根肋骨移植于胸骨下端。病例3采用向下完全切开胸骨,做成胸骨全裂后缝合胸骨。病例4为新生儿,采用向下楔形切除部分胸骨后向正中聚拢胸骨。结果 全组患儿手术矫形顺利,心肺无明显受压表现。随访8个月-6年,胸壁外观、心肺功能及生活状态满意。 结论 胸骨裂手术时机的把握和手术方法的选择与患儿的年龄、病变范围以及合并畸形密切相关。针对患儿的不同情况制定个体化治疗策略,可以达到满意的治疗效果。Objective To summarize the clinical experience of surgical correction on children with sternal cleft.Methods From Dec.,2006 to Oct.,2012,4 children （2 male,2 female）with sternal cleft who underwent surgical correction were reviewed retrospectively.Case 1 and case 2 who suffered from thoracicabdominal ectopia cordis were diagnosed as pentalogy of Cantrell.Case 3 and case 4 were diagnosed as asymptomatic superior sternal cleft.We repaired the defects in the anterior diaphragm,lower sternum,abdominal wall and diaphragmatic pericardium of case 1 and case 2.Intracardiac anomalies of the 2 patients included one case with a small membranous ventricular septal defect which was not required for surgical correction and another case with double outlet right ventricle which had one-stage repair.Case 1 and case 2 got sliding chondrotomies in which oblique incisions through the costal cartilages were performed to increase their length,and two ribs were used to close the large sternal cleft in case 1 additionally.In case 3 the caudal bridge was dissected in the midline conveying the partial cleft to a total one,which resulting in a closure of the cleft from epigastrium to the jugulum.Approximation of the sternal bar was facilitated by wedge osteotomy of the distal sternum in case 4 who was neonate.Results The operations on all patients were performed successfully without compression of heart and lung.No serious complications occur during the followup period （8 months to 6 years）.Every case live a wonderful life.Conclusions The surgical procedure depends on the age of the patient,on the form of the sternal cleft,and on the presence of additional malformations.Because of the rarity of the condition,the surgical procedure needs to be tailored to the individual defect.

关 键 词：胸骨裂 CANTRELL五联症 儿童 手术 

分 类 号：R726.2[医药卫生—儿科]