扩大端侧吻合一期矫治208例小儿主动脉缩窄合并室间隔缺损的疗效  

The experience of one-stage surgical treatment with extended end-to-side anastomosis for 208 cases with aortic coarctation combined with ventricular septal defect

作　　者：刘湘 邵奕嘉[3] 马力[1,2] 邹明晖 陈伟丹[1,2] 崔彦芹 陈欣欣[1,2] LIU Xiang;SHAO Yijia;MA Li;ZOU Minghui;CHEN Weidan;CUI Yanqin;CHEN Xinxin(Heart Center,Guangzhou Women and Children s Medical Center,Guangzhou Medical University,Guangzhou,Guangdong 510623,China;Guangdong Provincial Key Laboratory of Research in Structural Birth Defect Disease,Guangzhou,Guangdong 510623,China;Division of Hypertension and Vascular Diseases,the First Affiliated Hospital,Sun Yat-sen University,Guangzhou,Guangdong 510080,China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心心脏中心,广东省广州市510623 [2]广东省结构性出生缺陷疾病研究重点实验室,广东省广州市510623 [3]中山大学附属第一医院高血压血管病科,广东省广州市510080

出　　处：《中国动脉硬化杂志》2021年第6期523-528,共6页Chinese Journal of Arteriosclerosis

基　　金：广州市妇女儿童医疗中心/儿科研究所内部科研基金(YIP-2018-026)。

摘　　要：目的总结本中心近年来以扩大端侧吻合法一期矫治小儿主动脉缩窄合并室间隔缺损的手术疗效及经验。方法选取2010年1月—2017年10月在本院行一期手术治疗的主动脉缩窄合并室间隔缺损的患儿,共208例,其中男性137例,女性71例,中位年龄54(5~730)天,中位体质量4.0(1.8~9.9)kg。胸骨正中单一切口下,以扩大端侧吻合矫治主动脉缩窄,同期修补室间隔缺损。所有手术由同一组外科医师完成。应用SPSS 20.0统计软件进行数据录入和分析。结果术后早期死亡6例(2.9%),晚期死亡3例(1.4%);再缩窄16例(7.7%),再手术19例(9.1%)。脑钠肽在术前即存在明显升高,但术后未发生明显变化;主动脉缩窄段压差在术后明显下降,经皮血氧饱和度在术后明显上升。C反应蛋白、乳酸和肌酐水平在术后明显上升。术前合并高血压104例(53.0%),术后血压降至正常30例(28.8%),术后血压继续升高35例(33.7%)。术后吻合口压差较高是术后再缩窄的高危因素。结论胸骨正中单一切口下,扩大端侧吻合法一期矫治主动脉缩窄合并室间隔缺损,死亡率和再缩窄率低,取得良好的近中期疗效。术后吻合口压差较高是主动脉缩窄复发的高危因素。Aim To summarize the experience of one-stage surgical treatment of aortic coarctation(CoA)combined with ventricular septal defect(VSD)with extended end-to-side anastomosis in recent years.Methods The data from 208 cases with CoA combined with VSD admitted to hospital between January 2010 to October 2017 were collected and analyzed.There were 137 boys and 71 girls,the median age was 54(5~730)days,the median weight was 4.0(1.8~9.9)kg.Extended end-to-side anastomosis was used to correct the CoA,and the VSD was repaired simultaneously by an incision through median sternotomy.All operations were performed by the same group of surgeons.The data were analyzed by SPSS 20.0.Results Early death occurred in 6 cases(2.9%)and late death occurred in 3 cases(1.4%).Recoarctation developed in 16 cases(7.7%)and reoperation occurred in 19 cases(9.1%).The level of brain natriuretic peptide(BNP)increased remarkably before operation but showed no obvious change after operation.After operation,transcoarctation gradient pressure was reduced,and the transcutaneous oxygen saturation,C-reactive protein(CRP),lactate and creatinine were increased.Preoperative hypertension existed in 104 cases(53.0%),and after operation,blood pressure returned to the baseline level in 30 cases(28.8%)and continued to rise in 35 cases(33.7%).Higer transcoarctation gradient was the risk factor for postoperative recoarctation.Conclusions Correcting the CoA combined with VSD simultaneously with extended end-to-side anastomosis by an incision through median sternotomy was effective and safe,and the outcomes of immediate and medial-term were satisfactory,with low rates of mortality and recoarctation.Higer transcoarctation gradient pressure was the risk factor for postoperative recoarctation.

关 键 词：主动脉缩窄合并室间隔缺损 扩大端侧吻合 一期手术 再缩窄 

分 类 号：R6[医药卫生—外科学]