主动脉缩窄合并弓发育不良新生儿外科治疗的单中心回顾性研究  

Surgical management of neonatal coarctation of the aorta with aortic arch hypoplasia:A retrospective study in a single center

作　　者：任秋实 惠成一 温树生[2] 岑坚正[2] 刘晓冰[2] 黄美萍 邱海龙 季尔超 陈天钰 余觉愍 庄建 REN Qiushi;HUI Chengyi;WEN Shusheng;CEN Jianzheng;LIU Xiaobing;HUANG Meiping;QIU Hailong;JI Erchao;CHEN Tianyu;YU Juemin;ZHUANG Jian(Department of Cardiac Surgery,School of Medicine,South China University of Technology,Guangzhou,510006,P.R.China;Department of Cardiac Surgery,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangdong Cardiovascular Institute,Guangzhou,510080,P.R.China;Department of Catheterization Laboratory,Guangdong Provincial People's Hospital,Guangdong Academy of Medical Sciences,Guangdong Cardiovascular Institute,Guangzhou,510080,P.R.China)

机构地区：[1]华南理工大学医学院,广州510006 [2]广东省人民医院广东省医学科学院广东省心血管病研究所心外科,广州510080 [3]广东省人民医院广东省医学科学院广东省心血管病研究所介入导管室,广州510080

出　　处：《中国胸心血管外科临床杂志》2023年第6期890-896,共7页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：广东省科技计划项目(2019B020230003);广州市科技计划项目(202206010049)。

摘　　要：目的总结主动脉缩窄合并主动脉弓发育不良新生儿的手术治疗经验。方法回顾性纳入2013—2020年于广东省人民医院小儿心脏外科接受手术治疗的主动脉缩窄合并弓发育不良新生儿,分析患儿术后并发症、远期生存率、免于主动脉再梗阻等情况。根据手术方式将患者分为3组:扩大端端组(行扩大端端吻合术),扩大端侧组(行扩大端侧吻合术),补片扩大组(行肺动脉补片扩大术)。结果纳入患者44例,其中男37例、女7例,年龄5.00~30.00(19.34±7.61)d,体重2.00~4.50(3.30±0.60)kg。扩大端端吻合术19例,扩大端侧吻合术19例,肺动脉补片扩大术6例。主动脉近弓、远弓、峡部管径Z值的平均值分别为–2.91±1.52、–3.40±1.30、–4.04±1.98。平均随访(45.6±3.7)个月。早期死亡2例,无随访期内死亡。3例进行再手术干预,8例出现主动脉再梗阻,5年免于再梗阻率为78.8%。多因素Cox回归分析显示:远期再梗阻相关因素为术前主动脉近弓管径Z值[HR=0.152,95%CI(0.038,0.601),P=0.007]、术后早期左主支气管受压[HR=15.261,95%CI(1.104,210.978),P=0.042]。结论新生儿期进行主动脉缩窄合并弓发育不良的3种手术术式治疗均安全有效,但术后远期再梗阻率不低。术前主动脉近弓管径Z值小、术后早期左主支气管受压是远期再梗阻的独立危险因素。Objective To summarize the surgical treatment experience in neonates with coarctation of aorta(CoA)and aortic arch hypoplasia(AAH).Methods The clinical data of 44 neonates with CoA and AAH who underwent surgical treatment in the Department of Pediatric Cardiac Surgery of Guangdong Provincial People's Hospital from 2013 to 2020 were analyzed retrospectively,including 37 males and 7 females,aged was 5-30(19.3±7.5)days and weighted 2-4.5(3.3±0.6)kg.The postoperative complications,long-term survival rate,and freedom from aortic reobstruction were analyzed.Results There were 19 patients of extended end-to-end anastomosis,19 patients of extended end-to-side anastomosis,and 6 patients of pulmonary autograft patch aortoplasty.The mean values of the Z scores of the proximal,distal,and isthmus of the aortic arch were-2.91±1.52,-3.40±1.30,and-4.04±1.98.The mean follow-up was 45.6±3.7 months.There were 2 early deaths and no late deaths.Aortic re-obstruction occurred in 8 patients,and 3 patients underwent reoperation intervention.The 5-year reobstruction freedom was 78.8%.The Cox multivariate regression analysis showed that the related factors for postoperative reobstruction were the Z score of the preoperative proximal aortic arch(HR=0.152,95%CI 0.038-0.601,P=0.007)and the postoperative left main bronchus compression(HR=15.261,95%CI 1.104-210.978,P=0.042).Conclusion Three surgical procedures for neonates with CoA and AAH are safe and effective,but the aortic reobstruction rate in long term is not low.The smaller Z score of the preoperative proximal aortic arch and the postoperative left main bronchus compression are risk factors for long-term aortic reobstruction.

关 键 词：主动脉缩窄 主动脉弓发育不良 先天性心脏病 新生儿 手术治疗 

分 类 号：R726.5[医药卫生—儿科]