非体外循环下危重主动脉缩窄新生儿左胸后外侧切口手术的效果分析  

Analysis of the effect of coarctation of aorta in critically neonatal under off-pump

作　　者：陈仁伟 王海凡 艾力夏提·阿里甫 苏云天 刘锦纷 Chen Renwei;Wang Haifan;Ailixiati·alifu;Su Yuntian;Liu Jinfen(Department of Thoracocardiac Surgery,Hainan Women And Children's Medical Center,Hainan children's Hospital,Haikou,570206,China;Department of Thoracocardiac Surgery,Shanghai Institute of Pediatric Congenital Heart Disease,Shanghai,200120,China)

机构地区：[1]海南省妇女儿童医学中心(海南省儿童医院)心胸外科,海南省海口市570206 [2]上海市小儿先天性心脏病研究所,上海市200120

出　　处：《临床小儿外科杂志》2021年第9期861-865,共5页Journal of Clinical Pediatric Surgery

基　　金：海南省卫生健康行业科研项目(编号:20A200158);海南省临床医学中心建设项目。

摘　　要：目的总结非体外循环下危重主动脉缩窄新生儿行左胸后外侧切口手术的手术经验,探讨其安全性和有效性。方法以海南省妇女儿童医学中心2018年5月至2020年12月收治的28例危重主动脉缩窄的新生儿患者为研究对象,均行左后外侧切口非体外循环下主动脉缩窄矫治手术。日龄5~26 d,平均(14.3±5.9)d;体重2.5~4.5 kg,平均(3.7±0.5)kg。结果28例中,16例行主动脉缩窄段切除加扩大端端吻合,12例因合并弓形发育不良,行主动脉缩窄段切除加扩大端侧吻合术。全组无一例死亡、神经系统并发症、中转体外循环下手术以及旁路转流病例。随访3~35个月,平均12.3个月。术后多普勒超声测定跨修复点压力阶差较术前显著降低(P<0.05),无一例早期再干预病例。术后3个月多普勒超声测定主动脉弓降部最大压力阶差<10 mmHg 15例(53.6%),10~20 mmHg 11例(39.3%),>20 mmHg 2例(7.1%)。结论非体外循环下新生儿危重主动脉缩窄患者行左胸后外侧切口手术安全可行,病死率低,早期结果良好,但长期结果还需要进一步随访。Objective To introduce the indications and experiences of surgery for coarctation of the aorta in critically ill neonates with a left posterolateral thoracic incision under off-pump circulation,and to explore its safety and effectiveness.Methods From May 2018 to December 2020,28 cases of neonates with critically ill aortic coarctation underwent left posterolateral incision and off-pump aortic coarctation surgery.Age 5~26 days(14.3±5.9)d;weight 2.5~4.5 kg(3.7±0.5)kg.Results The whole group of children were performed under non-cardiopulmonary bypass,and there were no cases of transferring to cardiopulmonary bypass or bypass.16 patients underwent aortic constriction resection and enlarged end-to-end anastomosis,and 12 patients with arch dysplasia underwent aortic constriction resection and enlarged end-to-side anastomosis.There were no surgical deaths and no neurological complications in the whole group.The follow-up period was 3~35 months,with an average of 12.3 months.The postoperative Doppler ultrasound measurement of the pressure gradient across the repair point was significantly lower than that before the operation.There were no cases of early intervention and aortic-related airway problems.In 3 months postoperatively,Doppler ultrasound measured the maximum pressure difference of the descending aortic arch in 15 cases(53.6%)<10 mmHg,11 cases(39.3%)10~20 mmHg,and 2 cases(7.1%)>20 mmHg.Conclusion Aortic coarctation surgery for critically ill neonates under non-cardiopulmonary bypass left posterolateral incision is a safe method with low mortality and beneficial early outcome,but its long-term outcome needs further follow-up.

关 键 词：主动脉缩窄 外科手术 非体外循环 治疗结果 婴儿 新生 

分 类 号：R543.1[医药卫生—心血管疾病] R726.1[医药卫生—内科学]