正中切口一期纠治婴幼儿先天性主动脉缩窄伴室间隔缺损  

Surgical repair of infantile coarctation of aorta with ventricular septal defect in one-stage by median sternotomy

作　　者：徐志伟[1] 陈会文[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海儿童医学中心小儿心胸外科

出　　处：《上海医学》2003年第8期557-559,共3页Shanghai Medical Journal

摘　　要：目的　总结先天性心脏病主动脉缩窄伴室间隔缺损一期纠治的手术方法和临床经验。方法　1999年 1月～ 2 0 0 1年 12月 ,采用胸骨正中切口一期纠治 12例主动脉缩窄伴室间隔缺损患儿 ,手术年龄除 2例分别为 39和 2 9个月外 ,其余均小于 6个月 ;体重 2 .5～ 11.0kg ,平均为 (5 .2 4± 2 .77)kg。主动脉缩窄位于导管前型 6例 ,邻近动脉导管处 3例 ;主动脉弓发育不良伴主动脉缩窄 3例。 5例伴有动脉导管未闭 ;11例伴有室间隔缺损 ,其中 7例缺损位于膜周 ,4例位于肺动脉瓣下 ;1例伴有部分性房室隔缺损。手术采用胸骨正中切口 ,同时纠治主动脉缩窄和室间隔缺损。结果　死亡 1例 ,该例患儿年龄为 1个月 ,体重 2 .5kg ,外院转来时全身黄疸、慢性心功能不全 ,术后因心力衰竭而死亡 ,本组病死率为 8.3%。余 11例术后随访 5～ 30个月 ,恢复良好。结论　正中切口一期纠治婴幼儿先天性心脏病主动脉缩窄伴室间隔缺损 ,不仅可缩短手术时间 ,有利于术后心肺功能恢复 。Objective To summarize and review the surgical repair of coarctation of the aorta (Coa.Ao) with ventricular septal defect (VSD) in one stage by median sternotomy. Methods Between January 1999 and December 2001, twelve patients with Coa.Ao accompanied by VSD were operated. The patients' age was less than 6 months except 2 were 39 months and 29 months respectively; the body weights were 2.5～11.0 kg [mean (5.24±2.77) kg]. The site of Coa.Ao was preductal in 6 patients, juxtaductal in 3 and diffuse hypoplasia of aortic arch in 3. These patients had other associated congenital heart diseases such as PDA in 5, VSD in 11 and partial A V canal in 1. The Coa.Ao and associated intracardiac defects were repaired at the same time by median sternotomy. Results One patient died of heart failure who was 1 month of age and 2.5 kg in weight. He had critical heart failure and jaundice before operation. The operative mortality was 8.3%. Eleven patients were followed up from 5 months～30 months and the results were satisfactory. Conclusion Infantile Coa.Ao with VSD can be repaired by median stenotomy in one stage. This operative approach is beneficial, not only with shortened duration of operation, but also advantageous for the recovery of cardiac and pulmonary function, moreover the diffuse hypoplasia of aortic arch can be corrected at the same time.

关 键 词：先天性主动脉缩窄 室间隔缺损 外科手术 手术方法 临床经验 婴幼儿 

分 类 号：R726.5[医药卫生—儿科]