心包大部分切除术治疗小儿急性心包炎

Extended partial pericardiectomy to treat acute suppurative pericarditis in children

目的 评价心包大部分切除术治疗小儿急性心包炎的临床效果。方法 对 1992～1999年收治的 35例小儿急性心包炎的手术、术后并发症及预后进行了回顾分析。结果 术后引流时间 3～ 10d ,平均 5d ,全组均治愈 ,随访半年～ 7年疗效满意 ,无远期死亡及严重并发症。结论 小儿急性心包炎应早期诊断、及时手术。心包大部分切除术 ,简单易行 ,可彻底解除心包填塞症状 ,避免遗留心包粘连或缩窄 ,缩短住院时间。目前随着结核发病率的增高 ,结核性心包炎的发病亦随之增加 ,应引起足够重视。

Objective To assess the clinical outcome of extended partial pericardiectomy in the treatment of pediatric acute suppurative pericarditis. Methods The clinical presentations, operative method and outcomes of 35 cases (male 26,female 9) with acute suppurative pericaritis were analyzed (March 1992 to September 1999).The mean age was 8 years (range: 2.5to 13.3 yr). The mean duration between the onset of clinical symptoms and operation was 16?days( 7～30?days).All patients had high fever, dyspnea,and systemic toxic symptoms. Twenty-eight patients had bronchitis,21 associated with suppurative arthritis or osteomyelitis around ankles or hips, while 4 patients were secondary infection brought on by tuberculous pericarditis.The diagnosis was made with chest X-ray,color Doppler, operative findings and pathologic examination. Wide partial pericardiectomies were carried out via left anteriorlateral thoracotomy with the anterior surface of involved pericardium removal.The amount of pus averaged 500 ml(300～ 1 000?ml).Results All patients have recovered. The chest drainage were removed 5?days post-operatively(3～10?d).The patients were followed-up for 6?months to 7?years. No long-term mortality or severe morbidity was observed.Conclusions Acute suppurative pericarditis should be diagnosed and treated early. Extended partial pericardiectomy is the procedure of choice. The operation is a simple and effective way of pus drainage, cardiac tamponade and pericardium constriction preventing. It also shortens hospitalization. With increasing incidence of tuberculosis,tuberculous pericarditis is becoming common. Greater awareness of the condition is recommended to minimize cardiac tamponado and sudden death in children.