肺动脉吊带手术治疗的早中期效果分析  

Comprehensive surgical treatment of pulmonary artery sling:a report of 52 cases at a single center

作　　者：陈小龙 沈立[1] 谢业伟[1] 李小兵[1] 龚瑾[1] 王蓓旎[1] 张儒舫[1] Chen Xiaolong;Shen Li;Xie Yewei;Li Xiaobing;Gong Jin;Wang Beini;Zhang Rufang(Department of Cardiac Surgery,Shanghai Children's Hospital,Shanghai Jiao Tong University,Shanghai 200062,China)

机构地区：[1]上海市儿童医院,上海交通大学附属儿童医院心胸外科,200062

出　　处：《中华小儿外科杂志》2021年第10期888-892,共5页Chinese Journal of Pediatric Surgery

摘　　要：目的探讨肺动脉吊带患儿的临床特点及手术治疗的早中期效果。方法收集2009年1月至2017年12月上海交通大学附属儿童医院心胸外科收治的52例肺动脉吊带患儿的相关资料。其中,男26例,女26例;年龄为(17.7±25.6)个月,年龄范围为3个月至11岁;体重为(9.6±5.1)kg,体重范围为3~32 kg。52例患儿均有不同程度的气管狭窄,26例同时合并其他先天性心脏病。41例患儿Ⅰ期行非体外循环下左肺动脉重建术,9例患儿Ⅰ期行体外循环下左肺动脉重建术,2例患儿Ⅰ期行体外循环下左肺动脉重建术+滑动气管成形术。对所有患儿按照两种方式分组研究,①将术中行气管干预的5例患儿作为气管干预组(干预组),将未行气管干预的47例患儿作为气管为干预组(未干预组);②将术中建立体外循环的13例患儿作为体外循环组(循环组),将未建立体外循环的39例患儿作为非体外循环组(无循环组)。评估比较干预组与未干预组患儿气管狭窄指数;比较循环组和无循环组患儿术后机械通气时间、监护室时间及住院时间。结果所有患儿中,41例患儿Ⅰ期行非体外循环下左肺动脉重建术;1例手术失败,术后12 dⅡ期行左肺动脉重建+滑动气管成形术,术后撤机困难,家长放弃后死亡;1例术后因多次呼吸机撤机失败,行气管内支架植入术,术后恢复良好;1例患儿术后随访11个月,因气管狭窄加重,反复肺炎发作住院再次入院行滑动气管成形术,术后恢复好。9例患儿Ⅰ期行体外循环下左肺动脉重建术,术后死亡2例。2例患儿Ⅰ期行体外循环下左肺动脉重建术+滑动气管成形术,手术均顺利完成。18例同期矫治合并的其他先天性心脏病;1例同期纠治膈膨升。死亡3例,存活患儿出院后随访时间范围为2~10年,呼吸道症状均减轻或消失。气管狭窄指数在干预组和未干预组患儿间的差异具有统计学意义(P<0.05)。术后机械通气时间、监护�Objective To explore the clinical characteristics of children with pulmonary artery sling(PAS)and to analyze the early and mid-term efficacy of operation.Methods From January 2009 to December 2017,52 PAS children were analyzed retrospectively.There were 26 boys and 26 girls with an average age of(17.7±25.6)(3-132)months and an average body weight of(9.6±5.1)(3-32)kg.All of them had varying degrees of tracheal stenosis.Twenty-six cases were complicated with other congenital heart diseases(CHDs).During primary surgery,left pulmonary artery(LPA)re-implantation off-pump(n=41),LPA re-implantation under cardiopulmonary bypass(n=9)and LPA re-implantation&sliding tracheoplasty under cardiopulmonary bypass(n=2)were performed.The study was grouped in two ways.The first grouping was for designating intraoperative tracheal intervention(n=5)and non-intervention(n=47)groups;The second grouping cardiopulmonary bypass as cardiopulmonary bypass(circulation,n=13)and non-cardiopulmonary bypass(non-circulation,n=39)groups.To evaluate and compare the tracheal stenosis index in the non-intervention group;to compare the postoperative mechanical ventilation time,intensive care unit time and hospital stay in the circulatory non-circulation group.Results Among them,41 children underwent LPA re-implantation off-pump and 1 failed case had LPA re-implantation and slide tracheoplasty after 12 days.Due to difficult postoperative extubation,the parents gave up;1 child underwent endotracheal stent implantation because of extubation failure and recovered well postoperatively;after a follow-up period of 11 months,1 case was admitted for slide tracheoplasty because of an aggravation of tracheal stenosis.Nine children underwent LPA re-implantation under cardiopulmonary bypass and there were two postoperative deaths.Two children underwent LPA re-implantation and slide tracheoplasty successfully.And concurrent conditions included other CHDs(n=18)and diaphragmatic distention(n=1).Three children died and the survivors were followed up for 2 to 10 year

关 键 词：体外循环 肺动脉吊带 气管狭窄 外科手术 

分 类 号：R726.5[医药卫生—儿科]