摘要
目的探讨新生儿婴幼儿期主动脉弓中断（IAA）I期矫治的手术经验和随访结果，提示关注后续治疗。方法2010年9月至2014年12月，单一手术组连续收治38例IAA患儿，男26例，女12例；年龄1天～5个月，中位值11天；体质量1．8～5．8kg，中位值4．1kg。解剖学分型：A型24例（63．16％），B型13例（34．21％），C型1例（2．63％）。2例单纯IAA合并动脉导管未闭（PDA），36例合并房间隔缺损、室间隔缺损（VSD）和PDA，其中7例合并左心室流出道梗阻（LVOTO）（4例为瓣下狭窄，2例为瓣膜狭窄，1例为瓣下＋瓣膜狭窄），1例合并左肺动脉异常起源于主动脉，1例合并永存动脉干（Ⅱ型）。28例术前行CT造影并气管三维重建，合并气管狭窄5例。38例均有明显差异性发绀。2例术前死亡，36例行I期矫治。35例合并心内畸形患儿均经正中切口，体外循环采用升主动脉及动脉导管双插管灌注并将体温降至18℃～23℃，选择性脑灌注（21例）或停循环（14例）。完整切除导管组织，予7／0（或8／0）prolene线对端吻合主动脉弓。1例B型患儿因预期吻合口张力过大，切断左锁骨下动脉松解主动脉弓。合并心内畸形降温或复温过程中矫治。16例延迟关胸。1例A型单纯IAA经标准左后外侧切口矫治。制订严格的随访计划，密切注意主动脉弓再狭窄、LVOTO、气管狭窄等并发症，必要时给予再次手术或内科介入治疗。结果本组术前死亡2例，1例为C型IAA＋VSD＋PDA，另1例为单纯B型IAA。围术期死亡2例。随访过程中猝死1例。体外循环105—208min，中位值138min；选择性脑灌注或停循环16-35min，中位时间24min。1例术后即刻发生肺动脉高压危象死亡。呼吸机支持2～25天，其中1例气管重度狭窄患者，呼吸机撤机困难，继发感染和多脏器功能衰竭死亡。其余患者顺利出院，出院时上、下肢血压差均小于20mmHg�
Objective To discuss one-stage surgical repair of interrupted aortic arch （IAA） in neonates and young in- fants, summarize follow-up results and subsequent treatments. Methods From September 2010 to December 2014, a series of 38 consecutive neonates and young infants （M/F = 26/12 ） with IAA were admitted in our surgical group to receive surgical treatment, with a median age of 11 days（1 day to 5 months） and a median body weight of 4.1 kg（ 1.8 to 5.8 kg）. IAA was type A in 24 cases, type B in 13 cases and type C in 1 case. Associated cadiovascular anomalies were common except 2 cases, including atrial septal defect（ n = 23 ）, ventrieular septet defect （n = 36 ）, left ventricular outlet tract obstruction （LVOTO） （n = 7 ） , anomalous left pulmonary artery from aorta（ n -=- 1 ） , truneus arteriosus（ n = 1 ）. There were 5 cases of airway stenosis in 28 eases of CT angiography and 3D airway reconstruction. All the 38 cases were admitted with differential cyanosis. 36 eases were recieved one-stage surgical repair except 2 cases died before operation. 35 cases of IAA associated with intracardiae anom- alies were repaired through a median sernotomy. Cardiopulmonary bypass（CPB） was performed with two canulations in ascend-ing aorta and main puhnonary artery. Selective cerebral peffusion（ n = 2t ） or cin：ulatory arresl（ n = 14） was eanied out with body temperature of t 8℃-23℃. After the patent ductus arteriosus tissue was completely reseeted, a continuous end-to-end or end-to-side suturing with 7/0（8/0） prolene was performed. In 1 type B cases with expected excessive anastomotic tetMon, the left subclavian arlery was cut otf to release the aortie arch. The associated anomalies were repaired during the eooling or re- warming period. Chest close was delayed to earry out no more than 24 -72 b postoperatively in 16 eases. Tbe other one type A IAA case without intraeardiac annmaly was repaired through a standard let posterior lateral incision. Patients were strictly f
出处
《中华胸心血管外科杂志》
CSCD
2017年第1期5-9,共5页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
青岛市医疗卫生重点学科建设项目（2014-8）
关键词
心脏病
先天性
主动脉弓中断
外科手术
婴儿
新生儿
Heart disease, congenital lntenupted aortic arch Surgical procedure Infant, newbom
