一侧肺动脉起源于升主动脉的外科治疗

Surgical treatment for the anomalous origin of one side pulmonary artery from the aorta

目的:探讨一侧肺动脉起源异常的手术指征、方式以及效果。方法:回顾分析本院从2003年8月至2011年5月间16例手术治疗一侧肺动脉起源异常的患儿,男12例,女4例,中位年龄为4个月(13d～17岁),中位体重为5kg(3.6～50kg)。其中右肺动脉异位起源15例,大多合并动脉导管未闭或卵圆孔未闭,左肺动脉起源异常合并法乐四联症1例,手术同期矫治。手术方式多为异常肺动脉与主肺动脉直接吻合,2例年龄偏大的患儿存在严重肺动脉高压,术前进行肺活检手术,根据肺活检估计肺血管发育情况。结果:无手术及住院死亡,术后复查均未提示有肺高压表现,1例合并肺动脉残余梗阻,术后3个月后肺动脉压差明显降低至30mmHg,余病例无明显吻合口狭窄,2例大龄患儿手术效果符合肺活检结果。结论:16例患儿手术效果良好。年龄小患儿一般手术效果好,年龄大的患儿往往合并重度肺动脉高压,术前行肺活检评估有无手术指征,简单有效。

Objectives To investigate the operation indications, surgery methods and effects for the anomalous origin of one side pulmonary artery from the aorta. Methods Clinical data of 16 children （ 12 male and 4 female） with anomalous origin of one side pulmonary artery from the aorta underwent surgery from 2003 to 2012 were retrospectively analyzed. Among whom, 15 cases were right side pulmonary artery anomalous origin and complicated with PDA or PFO, 1 case was left side pulmonary artery anomalous origin and complicated with TOF, both underwent surgical correction in one stage. Results No death case and pulmonary hypertension was observed. The pulmonary artery pressure gap in 1 case, which combined with obstruction of pulmonary artery residue, was decreased to 30 mmHg. Conclusion The effects of the operation were good, which were increased with the decrease of the age of the children. Lung biopsy was important to help to make the decision of the operation and surgery methods for the aged children.