86例主动脉缩窄合并心内畸形患婴的一期手术治疗效果  

One-stage surgical treatment of 86 cases of aortic coarctation combined with intracardiac malformation

作　　者：吴雨昊 周悦航[1,2] 金鑫 况虹宇[2,3] 李勇刚 吴春[1,2] Wu Yuhao;Zhou Yuehang;Jin Xin;Kuang Hongyu;Li Yonggang;Wu Chun(Department of Cardiothoracic Surgery,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China;Ministry of Education Key Laboratory of Child Development and Disorders,China International Science and Technology Cooperation Base of Child Development and Critical Disorders,National Clinical Research Center for Child Health and disorders(Chongqing),Chongqing Key Laboratory of Pediatrics,Chongqing 400014,China;Department of Cardiology,Children’s Hospital of Chongqing Medical University,Chongqing 400014,China)

机构地区：[1]重庆医科大学儿童医院胸心外科,400014 [2]儿童发育疾病研究教育部重点实验室儿童发育重大疾病国家国际科技合作基地国家儿童健康与疾病临床医学研究中心(重疾)儿科学重庆市重点实验室,400014 [3]重庆医科大学儿童医院心血管内科,400014

出　　处：《中华胸心血管外科杂志》2019年第9期526-529,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的总结婴儿主动脉缩窄合并心内畸形一期矫治的效果.方法回顾性分析2009年8月至2017年8月86例主动脉缩窄合并心内畸形患婴的术前诊断、手术及术后情况.86例主动脉缩窄伴发心内畸形患婴中男56例,女30例.年龄(95.1±78.0)天,新生儿10例,占11.6%.体质量(4.6±1.2)kg.导管前型57例,导管旁型23例,导管后型6例.合并室间隔缺损73例,房间隔缺损59例,右心室双出口2例,心内型完全性肺静脉异位引流1例.结果所有患婴均接受了扩大端端吻合术、扩大端侧吻合术和主动脉弓补片成形术等一期手术纠治,同期矫治心内畸形.手术历时(279.0±56.4)min,体外循环(162.3±51.0)min,主动脉阻断(74.7±25.2)min.术后监护室停留(7.4±4.7)天,机械通气(101.1±75.4)h.出院前吻合口压差低于术前缩窄处压差,其差异有统计学意义[(42.3±17.7)mmHg对(22.1±9.4)mmHg,P<0.001],早期死亡7例.79例随访(31.0±27.4)个月,随访期间无死亡.末次随访吻合口收缩期压差(21.2±11.0)mmHg,29例吻合口压差大于20 mmHg,4例建议行球囊扩张.2年累积无再缩窄生存率69.2%.结论一期经胸骨正中入路治疗婴儿主动脉缩窄合并心内畸形手术安全且术后效果好,可避免早期二次手术,近-中期随访效果佳.Objective To summarize the clinical characteristics of coarctation of the aorta(CoA) associated with intracardiac anomalies in infants. Methods The data from August 2009 to August 2017 of 86 infants who were diagnosed with CoA associated with intracardiac anomalies. Preoperative diagnosis, surgical findings and post-operation follow-up were analyzed retrospectively. There were 56 boys an 30 girls, aqed(95.1±78.0) days, weight(4.6±1.2) kg. Anatomical types included 37 cases of pre-ductal CoA, 44 cases of peri-ducutal CoA, and 5 cases of post-ductal CoA. And this group also included 73 infants complicating VSD, 59 infants complicating ASD, 2 infants complicating DORV, and 1 infant complicating TAPVC. Results All of the included patients underwent single-stage repair of CoA associated with intracardiac anomalies. Mean operative time was(279.0±56.4) min, mean cardiopulmonary bypass time was(162.3±51.0) min, and mean aorta cross-clamp time was(74.7±25.2) min. Mean length of ICU stay and ventilation time were(7.4±4.7) days and(101.1±75.4) hours, respectively. The residual transcoarctation gradient before discharge was lower than pre-operative transcoarctation gradient significantly [(42.3±17.7) mmHg vs.(22.1±9.4)mmHg, P<0.001], and 7 early deaths were observed after surgery. The mean follow-up time of 79 hospital survivors was(31.0±27.4) months, and no late death was found. Transcoarctation gradient of hospital survivors in the last time follow-up was(21.2±11.0)mmHg. Transcoarctation gradient of 29 cases was higher than 20 mmHg, however, only 4 cases with significant clinical symptom of lower limbs retardation were recommended for ballon angioplasty consultant. The cumulative recoarctation-free survival in 2-year follow-up was 69.2%. Conclusion To avoid early second-stage operations, single-stage repair of CoA associated with intracardiac anomalies was effective and safe, and the outcomes of early to mid term follow-up were satisfactory.

关 键 词：先天性心脏病 主动脉缩窄 外科手术 婴儿 

分 类 号：R726.5[医药卫生—儿科]