摘要
目的评价常温非体外循环下外科治疗先天性导管后型主动脉缩窄(CoA)的早中期效果。方法回顾性分析1999年1月至2004年12月间,15例在常温非体外循环下施行 CoA 外科手术患者的临床资料。全组男11例、女4例;年龄(18±10)岁。CoA 为单纯性7例,合并动脉导管未闭(PDA)7例、合并 PDA 和室缺1例。在常温降主动脉部分阻断或主动脉弓-降主动脉临时旁路下施行人上血管旁路移植术9例;在常温降主动脉完全阻断施行腔内缩窄环切除加主动脉壁 Gore-Tex 补片成形术4例、缩窄段楔行切除端端吻合术2例。同期行结扎 PDA 8例,分期施行室缺修补术1例。结果全组无早期死亡,无声音嘶哑和下肢瘫痪。术后随访6个月～5年,下肢血压术后均较术前明显升高,术后有高血压者9例,其中需长期服用降压药者4例。无晚期死亡。术后人工血管通畅,降主动脉无再缩窄或假性动脉瘤形成。结论对于导管后型 CoA,无论是单纯性、还是伴有 PDA 或合并其他心内畸形但准备分期手术者,常温非体外循环下施行 CoA 矫正手术是安全和有效的。
Objective To evaluate the early and mid-term outcome of surgical repair for postductal coarctation of the aorta （CoA） under normothermia without cardiopulmonary bypass. Methods Clinic dada from 15 patients （11 males, 4 females, mean age 18±10 years） undergoing surgical repair for postductal CoA under normothermia without cardiopulmonary bypass between January 1999 and December 2004 were analyzed retrorespectively. There were 7 isolated cases, 7 cases associated with patent ductus arterious （ PDA）, 1 case with PDA and ventricular septal defects. Operation was performed under normothermia with partial cross-clamping of descending aorta in 8 cases, compete cross-clamping in 6 cases and temporary shunt in 1 case. Operative techniques adopted prosthetic bypass graft in 9 cases, Gore-Tex patch graft aortoplasty in 4 cases and stenosis resection with end-to-end anastomosis in 2 cases. PDA was ligated at single-stage in 8 cases. Ventricular septal defect was repaired at second stage in 1 case. Results No early and late death. Hypertension occurred in 9 cases during early postoperative period but was normalized gradually in 5 cases without medication during follow-up period, from 6 months to 5 years. The arterial blood pressure of lower extremities increased significantly and no hoarseness, paraplegia occurred after operation. No recoarctation and aneurysm formation were found during follow-up. Conclusion Surgical repair of postductal CoA under normothermia without cardiopulmonary bypass is safe and effective, which is a procedure of choice for patients with isolated CoA, CoA associated with PDA, or with other intracardiac anomalies that are ready to be repaired at second-stage.
出处
《中华外科杂志》
CAS
CSCD
北大核心
2007年第8期549-551,共3页
Chinese Journal of Surgery
关键词
主动脉缩窄
外科手术
体外循环
非
常温
Aortic coarctation
Surgical procedures, operative
Extracorporeal circulation, vwithout
Normothermia
