婴幼儿双主动脉弓合并Kommerell憩室的外科治疗  

Surgical treatment of double aortic arch with Kommerell diverticulum in infants

作　　者：丁楠[1] 郭健[1] 曹永丽[2] 朱耀斌[1] 伊寒露 赵宇东[1] 沈磊[1] 叶赞凯 李志强[1] Ding Nan;Guo Jian;Cao Yongli;Zhu Yaobin;Yi Hanlu;Zhao Yudong;Shen Lei;Ye Zankai;Li Zhiqiang(Department of Cardiovascular Surgery,Beijing Children's Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China;Department of Imaging Centre,Beijing Children’s Hospital,Capital Medical University,National Center for Children’s Health,Beijing 100045,China)

机构地区：[1]国家儿童医学中心,首都医科大学附属北京儿童医院心脏外科,100045 [2]国家儿童医学中心,首都医科大学附属北京儿童医院影像中心,100045

出　　处：《中华胸心血管外科杂志》2021年第3期159-162,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：北京市医院管理中心"青苗"基金(QML20191204)。

摘　　要：目的探讨婴幼儿双主动脉弓合并Kommerell憩室的诊断、手术方法、围手术期治疗及手术结果。方法首都医科大学附属北京儿童医院2014年12月至2019年12月手术治疗双主动脉弓合并Kommerell憩室22例,男14例,女8例,年龄(13.7±11.6)个月(1~36个月),体质量(9.8±3.4)kg(5~20 kg)。患儿术前伴有喘憋、气促、反复呼吸道感染、慢性咳嗽等呼吸道症状,术前均行心脏CT检查,憩室平均8 mm×9 mm,气管中下段受压程度56%±16%(30%~80%)。所有患儿左弓远端均闭锁,同时合并Kommerell憩室。手术方式为左主动脉弓分离、韧带分离和憩室切除。其中1例因气管软化严重术中同期放置气管支架。结果患儿监护室滞留(1.4±0.8)天(1~4天),术后住院(6.7±2.8)天(4~13天),均治愈出院。随访(25.5±16.9)个月(2~60个月),18例无明显持续性呼吸道症状,4例有轻微呼吸道症状。结论双主动脉弓合并Kommerell憩室的手术方式在分离闭锁端的主动脉弓和韧带时,同期切除憩室,早期预后良好,有可能消除残留症状和晚期并发症。Objective To investigate the diagnosis,surgical methods,perioperative treatment and surgical results of Kommerell's diverticulum with double aortic arch in infants.Methods From December 2014 to December 2019,22 cases of double aortic arch combined with Kommerell diverticulum were operated in our hospital,14 males and 8 females,with an average age of(13.7±11.6)months(1-36 months)and mean body mass of(9.8±3.4)kg(5-20 kg).The children had respiratory symptoms such as asthmatic suffocation,shortness of breath,repeated respiratory tract infection and chronic cough before operation.All patients underwent cardiac CT examination.The average diverticulum was 8 mm×9 mm,in the trachea The average compression degree of the lower segment was 56%±16%(30%-80%).The distal part of the left arch was atresia and Kommerell's diverticulum was found in all patients.The operation methods were left aortic arch separation,ligament separation and diverticulectomy.In one case,tracheal stent was placed simultaneously during the operation because of severe tracheal malacia.Results The average time in the ward was(1.4±0.8)days(1-4)days,and the average time in hospital was(6.7±2.8)days(4-13 days).The average follow-up period was(25.5±16.9)months(2-60 months).During the follow-up period,18 children had no persistent respiratory symptoms,and 4 children had only slight respiratory symptoms.Conclusion Kommerell's diverticulum can also be combined with double aortic arch.The operation method is to separate the aortic arch and ligament at the atresia end and resect the diverticulum at the same time.It has a good early prognosis and may eliminate the residual symptoms and late complications.

关 键 词：双主动脉弓 Kommerell憩室 儿童 

分 类 号：R726.5[医药卫生—儿科]