婴幼儿主动脉弓部病变合并心内畸形的外科诊治分析  

Surgical repair of aortic arch lesions in infants associated with intracardiac anomalies

作　　者：陈义初[1] 祁海杰 汪力 王涛[1] 龚立 皮名安 CHEN Yichu;QI Haijie;WANG Li(Department of Cardio Thoracic Surgery,Wuhan Children's Hospital,Wuhan 430016,China)

机构地区：[1]华中科技大学同济医学院附属武汉儿童医院心胸外科,430016

出　　处：《临床外科杂志》2021年第12期1135-1138,共4页Journal of Clinical Surgery

基　　金：武汉市卫生健康委重点科研项目(WX20A06);湖北省卫生健康委科研项目(WJ2021M020)。

摘　　要：目的分析婴幼儿主动脉弓部病变合并心内畸形一期弓部重建的诊治结果,总结临床经验。方法2018年1月~2020年12月我院心胸外科接受主动脉弓部重建手术的病人86例,合并心内畸形采用胸骨正中切口,用扩大的端-侧吻合法完成主动脉弓部重建,同期矫治心内畸形。单纯主动脉缩窄采用左胸后外侧切口,术中均采用自体心包片或牛心包补片扩大吻合口。重点关注术后残余梗阻、气管狭窄等并发症及处理。结果术后早期死亡3例(3/86,3.48%)。12例单纯主动脉缩窄在非体外循环下完成,余74例病人在深低温停循环下完成,停循环时间(18±3.2)分钟。存活病人术后均顺利脱离气管插管,术后呼吸机辅助时间(3.8±1.6)天,ICU停留时间(6.1±2.4)天。术后严重低心排行腹膜透析6例,2例行血液透析。ICU内床边开胸探查止血5例。4例患儿脱呼吸机困难,床边超声提示左侧膈肌活动度差,行膈肌折叠手术。失访2例,远期死亡1例。复发主动脉弓部梗阻者5例,其中1例梗阻严重,已接受再次手术。3例轻度梗阻继续观察中;16例病人术前存在不同程度的气管狭窄,术后均缓解。结论婴幼儿主动脉弓部病变,应尽早手术治疗。扩大的端-侧吻合法重建主动脉弓并同期矫治心内畸形治疗效果满意。术中充分游离,确保无张力吻合是预防术后并发症的关键。Objective To retrospectively analyze the treatment results of one-stage aortic arch reconstruction in infants with aortic arch disease and intracardiac malformation and summarize clinical experience.Methods The clinical data of 86 patients who underwent aortic arch surgery from January 2018 to December 2020 were retrospectively analyzed.Patients with intracardiac malformation,the reconstruction of the aortic arch was completed by an enlarged end-to-side anastomosis through a mid-sternal incision,and intracardiac malformation was corrected at the same time.Patients without intracardiac malformation,through the left thorax lateral incision.Postoperative follow-up focuses on complications such as residual aortic arch obstruction and tracheal stenosis.Results 3(3.48%)died.12 cases of simple coarctation of aorta were completed without CPB,and the remaining 74 cases were completed with deep hypothermic circulatory arrest.The circulatory arrest time was(18±3.2)min.The survival patients were separated from ventilator successfully,and the postoperative ventilator assisted time was(3.8±1.6)d,ICU stay time(6.1±2.4)d.6 cases underwent peritoneal dialysis and 2 cases underwent hemodialysis.5 patients underwent bedside thoracotomy for hemostasis in ICU.Postoperative atelectasis in 8 cases was improved after symptomatic treatment.4 patients had difficulty in weaning from ventilator,ultrasound showed poor activity of the left diaphragm,so diaphragmatic folding was performed.The follow-up time was 6 months to 6 years,2 cases were lost to follow-up,and 1 case died.5 cases of recurrent aortic arch obstruction,of which 1 case had severe obstruction and had received reoperation.3 cases of mild obstruction were still under observation;16 patients had different degrees of tracheal stenosis before operation,and relieved after operation.Conclusion Infants with aortic arch lesions should be treated as early as possible.The end-to-side anastomosis technique for the reconstruction of the aortic arch achieved excellent.Reducing the anasto

关 键 词：主动脉缩窄 主动脉弓发育不良 主动脉弓离断 婴幼儿 并发症 

分 类 号：R726.5[医药卫生—儿科]