[1]宁岩松,张供.婴儿主动脉弓阻塞病变的外科治疗[J].临床小儿外科杂志,2010,9(06):407.
　NING Yan song,ZHANG Gong,Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.[J].Journal of Clinical Pediatric Surgery,2010,9(06):407.
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婴儿主动脉弓阻塞病变的外科治疗

《临床小儿外科杂志》[ISSN:1671-6353/CN:43-1380/R] 卷: 第9卷 期数: 2010年06期 页码: 407 栏目: 出版日期: 2010-12-28
Title:
Surgical management of aortic arch obstruction associated with cardiac anomalies in infants.
作者:
宁岩松; 张供
山东大学齐鲁医院心外科（山东省，250022）
Author(s):
NING Yansong;  ZHANG Gong
Department of Cardiovascular Surgery, QiLu Hospital Affiliated to University of ShanDong, Jinan, 250022, China
关键词:
主动脉弓综合征; 主动脉缩窄; 畸形/外科学; 婴儿
Keywords:
Aortic Arch Syndromes; Aortic Coarctation; Abnormalities/SU; Infant
文献标志码:
A
摘要:
目的总结8年来56例婴儿主动脉弓阻塞病变的外科治疗经验。方法2001年5月至2009年6月，本院采取经正中切口一期矫治婴儿主动脉弓阻塞病变56例，其中男32例，女24例；年龄16 d至11个月；体重2.3～7.3kg；主动脉弓中断A型22例，B型3例；主动脉缩窄31例。合并室间隔缺损（VSD）及动脉导管未闭（PDA）55例，房间隔缺损（ASD） 6例，右室双出口（DORV)1例，完全性大动脉转位(TGA)1例。均采取经胸骨正中切口深低温停循环下一期矫治手术，采用降主动脉与主动脉弓端端吻合41例，端侧吻合前壁自体心包片加宽弓成形15 例。对合并圆锥部VSD者，为避免远期左室流出道梗阻采用0.4mm GoreTex补片Luciani法修补VSD。结果围术期死亡2例，病死率3.57%；出现喉返神经损伤2 例，跨主动脉弓压差3例，均<20 mmHg。54例存活患儿随访4个月至8年，生长发育良好，无远期主动脉狭窄及左室流出道梗阻，无神经系统并发症。多普勒超声测定跨修复点压力阶差(1.5±0.7)kPa，较术前(6.7±2.3)kPa，显著降低(t=2.51，P<0.05)。结论婴儿主动脉弓阻塞合并心内畸形宜早期手术治疗，经胸骨正中切口一期矫治手术安全有效。
Abstract:
ObjectiveTo summarize the experience of onestage repair of aortic arch obstruction associated with cardiac anomalies.MethodsBetween January 2001 and June 2009, 56 infant cardiac patients underwent onestage correction of interrupted aortic arch ( IAA, 25 cases) and coarctation of the aorta ( COA, 31 cases).All procedures were median sternotomy under cardiopulmonary bypass. The aortic arch reconstruction were endtoend anastomosis between the descending aorta and the arch in 41, endtoside anastomosis in 15, and ventricular septal defect was repaired with GoreTex patch. ResultsThere were 2 death ( overall mortality 3.57%) . The recurrent laryngeal nerves injuries in 2, the peaktopeak systolic pressure of aortic arch in 3(all lower than 20mmHg).All survivors were followed up for 4 month to 8 year. They were asymptomatic and developing normally. No later restenosis of anastomosis occurred and severe neurological complications were found.Conclusion Onestage complete correction of IAA and COA with cardiac anomalies through median sternotomy yields excellent intermediate surgical results.

参考文献/References:

1张玉龙,李仲智,李晓峰,等.主动脉弓阻塞合并心脏畸形18例的一期矫治\[J\].中国心血管病研究杂志,2007,5(1):13—15.
2Isomatsu Y,Imai Y,Shin’oka T,et al.Coarctation of the aorta and ventricular septal defect:should we perform a singlestage repair\[J\].J Thorac Cardiovasc Surg,2001,122(3):524—528.
3Haas F,Goldberg CS,Ohye RG,et al.Primary repair of aortic arch obstruction with ventricular septal defect in preterm and low birth weight infants\[J\].Eur J Cardiothorac Surg,2000,17(6):643—647.
4周燕萍,史珍英,蔡及明,等.主动脉缩窄手术与年龄的探讨\[J\].上海第二医科大学学报,2004,24:853—855.
5陈欣欣,张镜芳,庄建,等.经胸骨正中切口一期矫治小儿主动脉缩窄及合并畸形\[J\].中华胸心血管外科杂志,2006,22(6):374—376.
6Alfred EW,Hossein J.Is extended arch aortoplasty the operation of choice for infant aortic coarctationResults of 15 years’ experience in 181 patients\[J\].Ann Thorac Surg,2004,77:1353—1358.
7Gail EW,Cheryl AN.Extended resection and endtoend anastomosis for aortic coarctation in infants:results of a tailored surgical approach\[J\].Ann Thorac Surg,2005,80:1453—1459.
8Thomson DJ,Mulpur A.Outcome after extended arch repair for aortic coarctation\[J\].Heart,2006,9:90—94.
9Toro-Salazar OH,Steinberger J,Thomas W,et al.Longtern followup of patients after coarctation of aorta repair\[J\].Am JCardiol,2002,89(5):541—547.
10Corno AF,Botta U,Hurni M,et al.Surgery for aortic coarctation:a 30 years experience\[J\].Eur J Cardiothorac Surg,2001,20(6):1202—1206.
11Ilic′S,Vukovic′I,Hercog D,et al. Surgery for coarctation of the aortic in infants younger than three months\[J\].Srp Arh Celok Lek,2004,132(suppl 1):27-33.

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更新日期/Last Update: 2010-12-01