Zhang Jian,Wu Chun,Pan Zhengxia,et al.Surgical treatment of coarctation of the aorta by non-extracorporeal circulation ways:a report of 69 cases[J].Journal of Clinical Pediatric Surgery,2021,20(04):370-375.[doi:10.12260/lcxewkzz.2021.04.013]
非体外循环主动脉缩窄根治术治疗儿童主动脉缩窄的疗效分析
- Title:
- Surgical treatment of coarctation of the aorta by non-extracorporeal circulation ways:a report of 69 cases
- 分类号:
- R543.1;R726
- 摘要:
- 目的 评价儿童左后外侧入路非体外循环主动脉缩窄根治术的治疗效果。方法 回顾性分析重庆医科大学附属儿童医院2010年2月至2019年8月收治的经左后外侧入路非体外循环下行主动脉缩窄根治术的69例患者临床资料，其中男童38例，女童31例，年龄10.4（4.4，53.2）个月，体重8.0（5.0，14.5）kg。根据手术时年龄将患者分为低龄组（≤ 1岁）和高龄组（1~18岁）。手术均采用左后外侧入路非体外循环下进行，分析患者术前、手术时及术后临床资料，随访其中远期疗效。结果 全组术后无一例死亡病例。36例（52%）采用端端吻合术，28例（41%）采用扩大端端或端侧吻合术，2例（3%）采用自体心包扩大补片，2例（3%）采用Gore-Tex人工补片扩大成形，1例（1%）采用左锁骨下动脉翻转术。平均手术时间（141.3±37.3）min，平均主动脉阻断时间（25.6±8.6）min，术后ICU平均停留时间（6.2±4.6）d，术后机械通气时间的中位数和四分位间距为16.0（6.0，37.5）h，术后胸腔平均引流时间（5.4±3.9）d。出院前复查心脏彩超测得主动脉吻合口处压差为（27.9±12.0）mmHg，低于术前主动脉缩窄处压差[（60.9±20.5）mmHg]。与低龄组相比，高龄组患者手术时间、主动脉阻断时间、术后胸腔引流时间较长（P<0.05），术后ICU停留时间、术后呼吸机辅助通气时间较短（P<0.05）。全组患者随访期间无死亡病例，其中59例平均随访（49.9±31.8）个月，末次随访吻合口收缩期压差为（21.4±10.0）mmHg，2例行球囊扩张术，再干预率为3.4%。结论 左后外侧开胸非体外循环下主动脉缩窄的手术治疗，特别是对无需处理其他复杂心内畸形的患者而言安全且治疗效果好，具有较理想的中远期随访结果。
- Abstract:
- Objective To evaluate the therapeutic efficacy of coarctation of the aorta(CoA) via a left poster lateral approach by non-extracorporeal circulation pathways in children.Methods From February 2010 to August 2019, clinical data were analyzed retrospectively for 69 children undergoing radical operations for CoA via a left poster lateral approach by non-extracorporeal circulation pathways.There were 38 boys and 31 girls with a median age of 10.4(4.4, 53.2) months and a median weight of 8.0(5.0, 14.5) kilograms.Based upon operative age, they were divided into young group(≤ 1 year) and senile group(>1 and<18 years).All operations were performed via a left poster lateral approach by non-extracorporeal circulation pathways.Preoperative and perioperative clinical data were analyzed and medium/long-term outcomes were followed up.Results No patient died perioperatively.The approaches included end-to-end anastomosis(n=36, 52%), enlarged end-to-end/side anastomosis(n=28, 41%), pericardial patch aortoplasty(n=2, 3%), Gore-Tex artificial patch aortoplasty(n=2, 3%) and left subclavian flap aortoplasty(n=1, 1%).The operative duration was(141.3±37.3) min and the aortic cross-clamp time(25.6±8.6) min.The durations of intensive care unit(ICU) stay and ventilation were(6.2±4.6) days and 16.0(6.0, 37.5) hours.The postoperative length of thoracic drainage was(5.4±3.9) days.The gradient of residual transcoarctation pre-discharge on Doppler echocardiography was(27.9±12.0) mmHg.It was significantly lower than a preoperative transcoarctation gradient of(60.9±20.5) mmHg.As compared to young group, operative duration, time of aortic cross-clamp and length of thoracic drainage was longer(P<0.05).However, the durations of ICU stay and ventilation were shorter(P<0.05).No death occurred during follow-ups and 59 patients were followed up for(49.9±31.8) months.At the last follow-up, the transcoarctation gradient was(21.4±10.0) mmHg.Two children underwent balloon dilatation and the reintervention rate was 3.4%.Conclusion Surgical treatment of aortic coarctation by non-extracorporeal circulation pathways via a left poster lateral approach is both safe and effective for children without other complicated intracardiac malformations and has ideal mid-to-long-term follow-up outcomes.
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备注/Memo
收稿日期:2020-01-22。
基金项目:重庆市科委面上项目（编号：cstc2020jcyj-msxm0282）
通讯作者:吴春,Email:wuchun007@sina.cn