婴幼儿完全性血管环的早期外科治疗

The early surgery for complete vascular rings in infants and young children

目的评价完全性血管环的早期外科治疗效果。方法1999年3月至2006年6月手术治疗完全性血管环病儿16例，其中男7例，女9例。3月龄～3．2岁，平均（2．2±1．7）岁。术前均行超声心动图（ECHO）和心导管及心血管造影检查。诊断包括双主动脉弓6例；右位主动脉弓伴左侧韧带和左锁骨下动脉起源于降主动脉10例。术前麻醉诱导后和术毕行支气管镜检查比较。双主动脉弓通过切开次弓后部进入降主动脉的位置，将环离断；右位主动脉弓伴左侧韧带者，双重结扎离断动脉韧带或者离断后缝合两残端，迷走左锁骨下动脉起源于降主动脉处会有Kommerell憩室予切除，切下左锁骨下动脉转移至左颈总动脉作端侧吻合。结果除1例病儿因术后2个月不能脱离呼吸机放弃治疗外，余病儿均生存。术后经支气管镜检查，受压迫的支气管腔均明显改善，7例病儿出现呼吸道并发症，术后监护时间延长，术后呼吸机辅助28～129h，5例病儿由于肺血管阻力高，吸一氧化氮（NO）治疗1周后好转。随访3个月～2年，左锁骨下动脉移植至左颈总动脉者术后彩色超声检查显示血流通畅，左侧桡动脉搏动良好。结论术前或术中支气管镜检查有助于确定狭窄的部位和程度，进一步明确气管软化或支气管软化的部位。早期完全性血管环手术治疗效果良好，尤其是迷走左锁骨下动脉在近降主动脉处横断后转移至左颈总动脉病例，远期随访满意。

Objective To evaluate the results of early surgery for complete vascular rings in infants and young children. Methods Sixteen patients with complete vasetdar tings were treated surgically in hospital from March 1999 to June 2006. They aged from 3 months to 3.2 years. Eehocardiography （ECHO） and cardiac catheterization were performed preoperatively, The diagnosis included double aortic arch in 6 eases and fight aortic arch with left ligamentum arteriosum in 10. Bronehosenpy were performed in all 16 patients preoperatively and intraoperative. The vasctdar ring caused by the double aortic arch was released by dividing the lesser arch at the posterior insertion site into the descending aorta. In the latter, the ligamentum was divided, the Kommerell divertictdum was resected and the left subclavian artery was transferred to the left carotid artery. Results All patients were alive. The bronehoseopie view showed bronehia cavity was decompressed obviously. 7 patients had longer ventilation time with due to the lung complications. The time with ventilator was from 28 to 129 hours. 5 patients were treated with NO for one week because of pulmonary hypertension. The ECHO showed unblocked blood flow from the left carotid artery to the left subclavian artery in the follow-up of 3 months to 2 years. Conclusion The bronehosenpy is important in the treatment of complete vasctdar rings and it suggests early correction, especially the method of transferring the left subclavian artery to the left carotid artery is effective.