摘要
目的:探讨肺动脉吊带患儿的手术治疗效果及手术治疗策略。方法:回顾性分析2017年2月至2022年7月山东大学附属儿童医院心脏外科收治的110例肺动脉吊带患儿的相关资料。男55例,女55例;年龄[M(IQR)]为9.0(10.6)个月(范围:1~96个月),体重7.8(3.5)kg(范围:2.5~25.0 kg)。110例患儿中,108例有不同程度的气管狭窄,2例气管完全正常。78例患儿同期行左肺动脉移植+气管成形术;30例因早期不具备气管成形手术技术仅行左肺动脉移植术(我院11例,外院19例),其中24例后期因呼吸道症状明显、活动耐力受限等需二期行气管成形术,6例目前未行气管干预。2例气管正常患儿仅行左肺动脉移植术。结果:78例同期手术患儿中,70例术后恢复顺利,随访1~65个月,呼吸道症状明显减轻或消失,活动耐力同正常同龄儿童。8例死亡:4例术后出现多重耐药菌感染,气管吻合口哆开或感染性休克;1例合并严重先天性心脏病,术后出现低心排血量综合征难以纠正;1例术中左肺动脉移植后受压,血压不能维持;2例术后出现消化系统疾病(粘连性肠梗阻、消化道出血),治疗无效。24例分期手术患儿术后随访1~84个月,因出现呼吸道症状,活动耐力下降,二期行气管成形术。8例气管未干预组患儿均顺利脱离呼吸机,短期内治愈出院。结论:肺动脉吊带患儿绝大多数合并气管狭窄。气管狭窄程度低、呼吸道症状不明显的患儿,可仅侧开胸行左肺动脉移植术。合并严重气管狭窄或呼吸道症状明显的患儿,建议同期行左肺动脉移植+气管成形术。
Objective To examine the effect of surgical treatment in children with pulmonary artery sling and the surgical treatment strategy.Methods Relevant data of 110 children with pulmonary artery sling admitted to the Department of Cardiac Surgery,Children′s Hospital Affiliated to Shandong University from February 2017 to July 2022 were retrospectively analyzed.There were 55 males and 55 females,aging(M(IQR))9.0(10.6)months(range:1 to 96 months).The weight was 7.8(3.5)kg(range:2.5 to 25.0 kg).Of the 110 patients,108 had different degrees of tracheal stenosis and 2 had normal trachea.Left pulmonary artery transplantation and tracheoplasty were performed in 78 patients.Left pulmonary artery transplantation was performed in 30 patients(11 in our hospital and 19 in other hospitals)due to the lack of an early tracheoplasty technique,in which 24 patients needed stageⅡtracheoplasty due to obvious respiratory symptoms and limited activity endurance,and 6 cases did not intervene.Two children with normal trachea only underwent left pulmonary artery transplantation.Results Among the 78 children who underwent surgery in the same period,70 cases recovered smoothly after surgery,of whom respiratory symptoms were significantly reduced or disappeared during the 1 to 65 months follow-up,with similar activity endurance to normal children of the same age.Eight cases died,including 4 cases of postoperative multi-drug resistant bacteria infection,died from tracheal anastomotic opening or septic shock,1 cases with severe congenital heart disease died from postoperative low cardiac output syndrome difficult to correct,1 case died from blood pressure could not be maintained due to the compressed left pulmonary artery after transplantation,2 cases of postoperative digestive system diseases(adhesive intestinal obstruction,gastrointestinal bleeding,etc.).The 24 patients in the staging group were followed for 1 to 84 months.All patients needed stageⅡtracheoplasty due to respiratory symptoms and decreased endurance to activity.Eight cases of
作者
徐惠惠
杨彦亮
毕思明
吕效政
王卫敏
庞亚昌
王广震
冯致余
Xu Huihui;Yang Yanliang;Bi Siming;Lyu Xiaozheng;Wang Weimin;Pang Yachang;Wang Guangzhen;Feng Zhiyu(Department of Cardiac Surgery,Children′s Hospital Affiliated to Shandong University(Jinan Children′s Hospital),Jinan 250000,China)
出处
《中华外科杂志》
CAS
CSCD
北大核心
2023年第11期994-1000,共7页
Chinese Journal of Surgery
基金
山东省科技示范工程(2021SFGC0503)。
关键词
心脏缺损
先天性
气管狭窄
肺动脉吊带
气管成形术
Heart defects,congenital
Tracheal stenosis
Pulmonary artery sling
Tracheoplasty
