摘要
目的:回顾总结新生儿主动脉弓中断一期手术治疗经验,探讨新生儿主动脉弓中断的最佳手术时机及手术方式。方法:自2012年10月至2017年10月,我中心共收治新生儿主动脉弓中断26例。男性19例,女性7例;手术年龄3~28 d,平均(17.3±1.6)d;体质量2.6~4.4 kg,平均(3.3±0.1)kg。解剖学分型:A型20例,B型6例。全部病例合并动脉导管未闭,合并主肺动脉间隔缺损1例,合并室间隔缺损25例,其中17例同时合并房间隔缺损。手术均采用正中切口,体外循环采用升主动脉及肺动脉干双插管灌注,先矫治心内畸形,体温降至20~25℃后选择性脑灌注。重建主动脉弓采用扩大端侧吻合17例,扩大端侧吻合+牛心包补片加宽前壁9例。结果:全组术中体外循环转流102~150 min,平均(127.5±15.8)min,主动脉阻断47~75 min,平均(62.3±9.5)min,选择性脑灌注时间20~46 min,平均(32.54±9.4)min。术后死亡2例,病死率7.7%。1例死于术后严重低心排综合征、脑出血,1例死于毛细血管渗漏综合征、肾衰竭。余患儿手术成功,痊愈出院。术后失访2例,随访22例,中位随访时间28个月(9~60个月)。无远期死亡,主动脉弓再狭窄1例,予以行经皮介入球囊扩张。结论:主动脉弓中断一旦诊断明确,应于新生儿期内施行手术。选择性脑灌注下一期矫治主动脉弓中断及其合并畸形手术效果满意。
Objective:Try to figure out the proper timing and proper proce,ure of choice of surgical therapy of interrupted aortic arch(IAA)in neonates by retrospective analysis of 26 cases in a single center.Methods:26 cases of neonatal IAA were surgical treated from Oct.2012 to Oct.2017,male 19 cases,female 7 cases,mean age(17.3±1.6)days(3-28 d),mean body weight(3.3±0.1)kg(2.6-4.4 kg).The anatomic subtype included type A 20 cases,type B 6 cases.All cases included patent ductus arteriosus,25 cases with ventricular septal defect,1 case with aortopulmonary window.All patients with cardiac anomalies underwent one-stage repair through median sternotomy.Cardiopulmonary bypass was performed with two canulations in ascending aorta and main pulmonary artery.After cardiac anomaly was repaired,selective cerebral perfusion was carried out with body temperature of 20-25℃.The aortic continuity was reestablished by enlarged side-end anastomoses in 17cases,enlarged sids-end anastomoses plus aortoplasty with patch in 9 cases.Results:CPB time was ranged from 102-150 min(127.5±15.8)min,aortic crossclamp time was 47-75 min(62.3±9.5)min,selective cerebral perfusion time was 20-46 min(32.54±9.4)min.There were 2 cases(7.7%)postoperative death.22 patients were followed up from 9 to 60 months.One case with aortic arch restenosis received percutaneous transcatheter ballon dilation.Conclusions:Positive surgical repair should be performed after definite diagnosis being made.The outcomes of one-stage repair of IAA and associated cardiac anomalies through median sternotomy with selective cerebral perfusion are excellent.
作者
王刚
周更须
王辉
蒙强
辛成雷
WANG Gang;ZHOU Gengxu;WANG Hui;MENG Qiang;XIN Chenglei(Department of Cardiac Surgery,BaYi Children’s Hospital,The Seventh Medical Center of PLA General Hospital,Beijing 100700,China)
出处
《心肺血管病杂志》
2019年第5期515-517,521,共4页
Journal of Cardiovascular and Pulmonary Diseases
关键词
主动脉弓中断
新生儿
Interrupted aortic arch
Neonates
