主动脉缩窄合并心内畸形的外科治疗的临床研究

Surgical Management on Coarctation of the Aorta and Associated Intracardiac Abnormalities

目的探讨主动脉缩窄合并心内畸形的外科治疗方法.方法 2003年1月至2010年3月共手术治疗CoA合并其他心内畸形11例,其中合并VSD5例,PDA2例,VSD+PDA4例.合并主动脉弓发育不良1例.全组均行一期矫治.9例采用胸骨正中切口加左后外侧切口进行矫治,行人造血管旁路植入术.2例行胸骨正中单一切口,动脉缩窄段切除端-端或端侧吻合术.结果全组无手术死亡,均顺利出院.随访3月至4a,术后恢复良好.复查心脏超声,无吻合口狭窄,无吻合口处动脉瘤形成.结论根据患者年龄选择适合的手术方式,主动脉缩窄合并心内畸形有良好的疗效。

Objective To study the efficacy of surgical management on coarctation of the aorta（CoA） and associated intracardiac abnormalities.Methods From Jan.2003 to Mar 2010,11 patients with CoA and associated with intracardiac abnormalities underwent surgical treatment.Five patients were accompanied by VSD,two associated with PDA and four with VSD and PDA.One patient with diffuse hypoplasia of aortic arch.All patients underwent one-stage repair.Left posterolateral thoracotomy combined with median sternotomy and a bypass with artificial graft were used in 9 patients.Single median sternotomy and excision of coarctation,end to side or end to end anastomoses was used in 2 patients.Results There was no death in all patients.All patients were followed up from 3 to 48 months.The results of all patients were satisfactory.The followed up echocardiography showed there was no coarctation and false aneurysm.Conclusion The appropriate surgical management according to the age of patients has satisfactory effect on CoA and associated intracardiac abnormalities.