小儿先天性主动脉缩窄的临床治疗

The surgical treatment of congenital coarctation of aorta in the neonates

目的；总结先天性主动脉缩窄的外科治疗经验。方法：2000年5月～2005年12月共手术治疗7例先天性主动脉缩窄患者，年龄5-12岁，3例单纯CoA，4例同时合并其他畸形。单纯CoA从左后外侧第4肋间进胸完成矫治术。合并PDA者，左后外侧开胸，先双重结扎动脉导管，然后完成矫治术。对1例合并VSD的病例，采取分期手术方法，2例合并PDA和VSD患者采用一期手术法。纠治CoA方法有：缩窄段切除行端端吻合术和补片扩大成形术。结果：术后动脉血压下肢超过上肢5例，与上肢相同2例。所有患者均顺利康复出院，未发生肾功能衰竭和下肢截瘫等严重并发症。出院后3个月-5年随访：无1例死亡，所有患者心功能良好，生活质量有明显提高。随访中超声心动图检查未提示有主动脉再缩窄，补片修补患者无假性动脉瘤形成。1例成年患者术后随访期间仍然存在高血压，经口服降压药得以控制。结论：①在手术时机的选择上，对症状较轻、处于心功能代偿期的儿童，手术可延迟到5～6岁时进行。②手术方式的选择应根据病变的具体情况和术者经验而定。狭窄段小于1．5cm，可选用端端吻合术；如狭窄段大于1．5cm。则选用补片成形术。③在合并畸形的处理上，尽可能选择一期矫治法。在一期矫治的切口选择方面，应首选双切口法。

Objective： To summarize the experiences of surgical treatment for congenital coarctation of aorta （CoA） . Methods： 7 patients aged 5 - 12 years with congenital CoA from May 2000 to Dec 2005, including 3 cases with simplex GoA and 4 cases with CoA combined other anomalies. For simplex CoA patients, the fourth left posterior lateral intercostal thoracotomy was used. 1 case diagnosed as CoA with patent ductus arteriosus （PDA） accepted left posterior lateral intercostal thoracotomy, the PDA was cut and sutured first, and then sep- arated carefully around the CoA and resection port of aortic coarctation. 1 patient required a two - stage repair for CoA and associated ventricular septal defect （VSD） . 2 cases diagnosed as CoA with PDA and VSD preoperatively accepted the two -stage repair. The types of surgical procedures mainly included resection and direct end - to - end anastomosis, and synthetic patch aortoplasty. Results： The blood pressure of lower extremity was higher than that of upper extremity in 5 cases after operation. There was no stage diversity of pressure for lower and upper extremity in 2 cases after operation. There was no paraplegia and kidney failure, 3 months - 5 years follow - up was available in all survivors. No patient died, and none had the recurrent obstruction through echocardiographic examination. Only 1 adult patient had systemic hypertension. Conclusion： ①Operations on the child with compensated cardial function may be put off until the child is 5 - 6 years old. ②The type of surgical procedure mainly depend on the experience of the surgeon and the coarctation. The length of coarctation less than 1.5 cm, resection and direct end - to - end anastomosis can be chosen; the length of coarctation more than 1.5 cm, synthetic patch aortoplasty should be chosen. ③It is a better way to correct the coarctation of aorta associated with other anomalies at one - stage. Double - incision is safe and effective.