电视胸腔镜下新生儿动脉导管未闭钳闭手术10例报告

Video-assisted Thoracoscopic Clipping of Patent Ductus Arteriosus in Neonates(A report of 10 cases)

目的对电视胸腔镜下新生儿动脉导管未闭(PDA)钳闭手术治疗的临床效果进行总结。方法 10例新生儿患者,男女各5例,PDA直径(3.49±0.83)mm,术前肺动脉压(9.02±3.55)kPa;合并有肺炎、贫血、缺氧性脑病、呼吸功能衰竭、心力衰竭、代谢性碱中毒等。在气静复合麻醉下全胸腔镜分离PDA,2枚钛夹钳闭PDA;所有病例均未留置胸腔引流管。结果所有病例均成功钳闭动脉导管,无导管或周围组织损伤出血等并发症。手术时间(29.3±8.2)min,术后用呼吸机辅助(19.36±29.23)h,住院天数(13.2±10.63)d。出院前心脏二维彩色超声心动图复查均未发现残余分流;无手术死亡病例。结论胸腔镜下动脉导管钳闭手术方法应为新生儿、早产儿PDA合并心力衰竭需急诊或限期手术的首选治疗手段,并可取得理想手术效果。

Objective A clinical study of video-assisted thoracoscopic interruption of patent ductus arteriosus（PDA） in neonates,who were complicated by congestive heart failure and lung infection.Methods Total 10 cases in our group,male and female 5 cases each.Average age（22.6±10.9） days;mean gestation period（35.8±4.4） weeks;mean body weight（2.7±0.61） kg;mean Apgar score 8.2;average PDA diameter（3.49±0.83）mm;other heart deformations including： atrial septum defect [mean diameter（3.15±1.61）mm] in 5 cases,severe tricuspid insufficiency in one case;mean pulmonary artery pressure（67.4±26.5） mmHg;other complicated diseases： pneumonia,anemia,anoxic encephalopathy,lung function failure,congestive heart failure,metabolic alkalosis,et al.All patients undergoing video-assisted PDA clipping with general aneasthesia.No chest tube drainage.Results All PDA in these cases were successfully interrupted with video-assisted thoracoscopic technique,no PDA injury and bleeding.Mean operating time（29.3±8.2） min;postoperative ventilating time（19.36±29.23） hours.No mortality.Echo examination before discharging,no residual shunt found;the diameters of pulmonary artery and left ventricle reduced（0.20±0.12）cm and（0.28±0.13）cm,respectively（P0.01）.LVEF（62±3.8）%.Mean postoperative days of hospital stay（13.2±10.6） days.Conclusion At present,video-assisted thoracoscopic technique is the best method for clipping of PDA in neonates and premature infants with congestive heart failure and can achieve satisfied clinical results.