动脉导管未闭的外科治疗

Surgical treatment of patent ductus arteriosus

目的：总结２０１例ＰＤＡ的外科治疗经验。方法：全组ＰＤＡ２０１例，单纯ＰＤＡ１７３例，ＶＳＤ＋ＰＤＡ１５例，ＴＯＦ＋ＰＤＡ９例，ＡＡＩ＋ＶＳＤ＋ＰＤＡ３例，ＡＶＳ＋ＰＤＡ１例，单纯ＰＤＡ结扎１５５例，ＣＰＢ下缝扎１８例。２８例并发心内畸形者２６例一期根治，２例分期手术。结果：全组死亡７列。死亡原因包括脑血管意外、低心排、人工血管渗血、急性肾衰和灌注肺。结论：多数单纯ＰＤＡ可经左开胸结扎，病程长，合并重度肺高压或ＳＢＥ者应在ＣＰＢ下缝扎。合并其他心内畸形者。

Objective: To summerize the experience of surgical treatment of 201 patients with patent ductus arteriosus. Materials and methods: The study included 201 patients with PDA.of them,173 were isolated PDA,15 with VSD,9 with TOF,3 with type AAI and VSD,and 1 with AVS.Of the 173 isolated PDA, 155 were closed with ligations through left posteriolateral incisions ,18 were operated under CPB. Of the 28 patients with other cardiac malformations,26 were operated in one stage uneder CPB,2 with VSD were operated in two stages-first ligating the PDA via left posteriolateral incision,6 months late, repairing the VSD under CPB.Results: Seven patients died postoperatively.The causes of death included:intracranial hemorrhage,low cardiac output,oozing of the dacron graft,ARF and reperfusion lung injury.Conclusion: Most of the isolated PDA could be closed through the left posteriolateral incision.For aged patients,severe PAH or SBE,the operation should be done under CPB; The closing of PDA associated with other cardiac malformations,could be done in one time or in separate times according to the patients'conditions.