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目的探讨不同手术方法治疗小儿主动脉弓部病变的效果。方法 78例主动脉弓部病变患儿,其中19例单纯主动脉弓缩窄(coarctation of aorta,COA)或合并小的房间隔缺损、轻度瓣膜反流等采用左后外侧切口,切除COA狭窄段行端端吻合;31例COA合并心内畸形采用体外循环下一期矫治弓部病变和心内畸形,端端吻合技术矫治;28例COA合并弓发育不良、心内畸形需一期矫治及主动脉弓离断(interruption of aortic arch,IAA)者采用扩大端侧吻合技术行主动脉弓重建。结果 3例死亡,未发生肾功能衰竭及神经系统并发症;右侧上下肢动脉压差由术前中位数压差43.2mm Hg下降至术后中位数压差2.4mm Hg,差异有统计学意义(P<0.01);超声检查跨狭窄段压差由术前(41.1±20.8)mm Hg下降至术后(16.3±11.1)mm Hg,差异有统计学意义(P<0.01);术后随访(11.2±3.1)个月,未发生吻合口再狭窄。结论个性化选择手术方式治疗小儿主动脉弓部病变,近、中期效果良好。
Objective To investigate the effect of different surgical methods on pediatric aortic arch lesions. Methods Totally 78 children with aortic arch lesion were enrolled in this study. Nineteen patients underwent aortic arch aorta (COA) or small atrial septal defect with mild valvular regurgitation. 31 cases of COA combined with intracardiac deformity were treated with the next stage of cardiopulmonary bypass undergoing cardiopulmonary bypass and endocardial deformity and end-to-end anastomosis. In 28 cases of COA complicated with bowel dysplasia, The interruption of aortic arch (IAA) underwent aortic arch reconstruction with augmented end-to-side anastomosis. Results Three patients died of renal failure and neurologic complications. The right and left lower extremity arterial pressure decreased from 43.2 mm Hg to 2.4 mm Hg, with a statistically significant difference (P <0.01). The pressure drop across the stenosis segment from the preoperative (41.1 ± 20.8) mm Hg to the postoperative (16.3 ± 11.1) mm Hg ultrasonography was statistically significant (P <0.01) Follow-up (11.2 ± 3.1) months, no anastomotic restenosis occurred. Conclusion Individualized surgical treatment of pediatric aortic arch disease, the near and medium-term effect is good.