肺动脉补片和心包补片治疗主动脉缩窄合并主动脉弓发育不良患儿的效果对比观察

A comparative study of pulmonary artery patch and pericardium patch in the treatment of coarctation of aorta with developmental dysplasia of aortic arch

目的研究肺动脉补片和心包补片在主动脉缩窄(CoA)合并主动脉弓发育不良患儿缩窄段切除联合主动脉成形术中的应用效果。方法回顾性分析2015年6月—2018年6月辽宁省辽阳市中心医院心外科CoA合并主动脉弓发育不良患儿50例临床资料,根据补片不同分为心包补片组(n=21)和肺动脉补片组(n=29),比较2组围术期指标及并发症发生情况、手术前后主动脉缩窄处压差变化以及术后3个月内再狭窄发生率。结果 2组术中均无并发症和死亡发生,术后随访3个月心包补片组出现严重心力衰竭1例,急性肾功能障碍1例;肺动脉补片组发生严重肺部感染1例,2组术中和术后并发症发生率未见明显差异(P>0.05)。2组术后主动脉缩窄处压差呈降低趋势且明显低于术前水平(P<0.01),术后1、3个月时压差均明显低于术后即刻(P<0.01),且心包补片组术后3个月时压差高于肺动脉补片组,差异有统计学意义(P<0.01)。术后随访3个月,心包补片组发生CoA再狭窄4例(19.05%),肺动脉补片组未见再狭窄病例。结论肺动脉补片主动脉成形术用于CoA合并主动脉发育不良患儿较心包补片更有利于降低主动脉缩窄处压差,并减少术后再狭窄发生。

Objective To study the effect of pulmonary artery patch and pericardial patch in coarctation of aorta(CoA)combined with aortic arch dysplasia in children.Methods A retrospective analysis was made of the clinical data of 50 children with aortic arch dysplasia complicated by CoA in cardiac surgery of Liaoyang Central Hospital from June 2015 to June 2018.According to the different patches,they were divided into pericardial patch group(n=21)and pulmonary artery patch group(n=29).The perioperative indexes and complications of the two groups were compared,as well as the changes of aortic coarctation pressure difference before and after operation and restenosis incidence within 3 months after operation.Results There were no complications and deaths in the two groups.There were 1 case of severe heart failure and 1 case of acute renal dysfunction in the pericardial patch group and 1 case of severe pulmonary infection in the pulmonary artery patch group.There was no significant difference in the incidence of complications between the two groups(P>0.05).The pressure difference of aortic coarctation in the two groups decreased and was significantly lower than that before operation(P<0.01).The pressure difference at 1 and 3 months after operation was significantly lower than that immediately after operation(P<0.01),and the pressure difference at 3 months after operation in the pericardial patch group was higher than that in the pulmonary patch group(P<0.01).Following up for 3 months,CoA restenosis occurred in 4 cases(19.05%)in pericardial patch group and no restenosis was found in pulmonary artery patch group.Conclusion Pulmonary patch aortoplasty in children with CoA and aortic dysplasia is more beneficial than pericardial patch in reducing the pressure difference of aortic coarctation and reducing the occurrence of restenosis after operation.