摘要
目的探讨主动脉弓补片加宽成形术和主动脉弓扩大端侧吻合术治疗主动脉弓缩窄合并主动脉弓发育不良的优缺点，为临床选择更合理的手术方法。方法回顾性分析2008年6月至2013年6月北京安贞医院45例主动脉弓缩窄合并主动脉弓发育不良患者的临床资料，根据手术中处理主动脉弓发育不良的方法不同，将45例患儿分为两组，I组：26例，其中男15例，女11例；年龄0．5～6．8（0．9±2．5）岁；体重5．0～20.3（9．5±7-3）kg；采用主动脉弓补片加宽技术；术前右侧上下肢压差（38-3±15．6）mmHg。Ⅱ组：19例，其中男14例，女5例；年龄0．6～7．5（1．0±2．7）岁；体重5．5～21．5（10．2±6．6）kg；采用扩大端侧吻合技术；术前右侧上下肢压差（40．7±16．1）mmHg。检测两组患儿手术后上下肢压力差的变化，并与手术前进行比较。结果全组共死亡2例（4．4％），其中l例死于低心排血量综合征，1例死于呼吸道感染。两组患儿均无肾功能衰竭及神经系统并发症。术后下肢收缩压高于上肢10～20mmHg28例，收缩压上、下肢相差小于10mmHg13例，上肢高于下肢20mmHg4例。右侧上下肢压差（3．2±13．5）mmHg，显著低于术前上下肢压差（P〈0．05）。组内比较：两组手术后上下肢压差明显低于术前（P〈0．05）。组间比较：两组之间上下肢压差术前、术后差异无统计学意义（P〉0．05）。随访38例，随访率88．4％，随访时间3个月至5年。随访期间1例患者出现主动脉弓降部血流速度进行性增快，主动脉弓压力阶差〉40mmHg，电子计算机断层扫描显示：主动脉弓再狭窄，于术后8个月再次行手术治疗；3例患者主动脉弓压力阶差〉20mmHg，仍在继续随访中；其余患者主动脉弓压力阶差均〈20mmHg。结论两种手术方式都是治疗主动脉弓缩窄合并主动脉弓发育不良的理想手术方法，应根据患�
Objective To evaluate the advantages and disadvantages of patch aortoplasty and extended side-to-end anastomosis for the treatment of coarctation of the aorta （CoA） and hypoplastic aortic arch, and provide a more reasonable surgical choice. Methods Clinical data of 45 patients who underwent surgical correction for CoA and hypoplastic aortic arch in Beijing Anzhen Hospital from June 2008 to June 2013 were retrospectively analyzed. According to different surgical strategies for aortic arch hypoplasia, all the 45 patients were divided into 2 groups. In group I, there were 26 patients inclu- ding 15 males and 11 females with their age of 0.5-6.8 （0.9±2.5） years and body weight of 5.0-20.3 （9.5±7.3） kg, who received patch aortoplasty and whose preoperative pressure gradient between right upper and lower limbs was 38.3 ＋ 15.6 mm Hg. In group II, there were 19 patients including 14 males and 5 females with their age of 0.6-7.5 （1.0±2.7）years and body weight of 5.5-21.5 （ 10.2± 6.6） kg, who received extended side-to-end anastomosis and whose preoperative pressure gradient between right upper and lower limbs was 40.7± 16.1 mm Hg. Postoperative changes of pressure gradient between right upper and lower limbs of the 2 groups were examined and compared with preoperative values. Results Two patientsdied postoperatively （4.4%） including 1 patient with low cardiac output syndrome and the other patient with severe lung infection. None of the patients in either group had renal failure or neurological complications. Postoperatively, there were 28 patients whose systolic blood pressure （SBP） of lower extremities was 10-20 mm Hg higher than that of upper extremities, 13 patients whose SBP gradient between upper and limbs was less than 10 mm Hg, and 4 patients whose upper limb SBP was 20 mm Hg higher than lower limb SBP. Postoperative average pressure gradient of right upper and lower extremities was 3.2 4- 13.5 mm Hg and significantly lower than preoperative value （P 〈 0.05 ）. Postoperative p
出处
《中国胸心血管外科临床杂志》
CAS
2014年第1期62-66,共5页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
