非体外循环主动脉弓缩窄外科手术体会

Experience of non-extracorporeal circulation surgical treatment of coarctation of aorta

目的:回顾性分析非体外循环外科治疗主动脉弓缩窄手术特点,探讨治疗主动脉弓缩窄的最佳手术方式。方法:回顾性分析我院2009年6月至2018年6月,收治的经左后外侧开胸行主动脉弓缩窄矫治术的患儿80例,依据手术方式分为两组,I组:62例,平均年龄12.2(6.0,37.3)个月;体质量(11±5.4)kg;采用主动脉端端吻合术。Ⅱ组:18例,年龄18.7(8.5,35.7)个月;体质量10.8(7.4,14.2)kg;采用左锁骨下动脉翻转补片成形术。观察两组患儿年龄、体质量、以及诊断、主动脉狭窄段部位、狭窄段长度、狭窄段内径等分布,并记录术前、术后上下肢收缩压峰值压差、术后呼吸机辅助呼吸时间、ICU滞留时间、术后随访上下肢血压等一般情况。结果:I组主动脉狭窄段长度(9.93±4.8)mm,最狭窄处内径(2.84±0.49)mm,II组狭窄段长度15(10,20)mm,最狭窄处内径(3.33±0.59)mm,两组病变,差异有统计学意义(P<0.05);I组术后呼吸机辅助时间为9(6.6,16.4)h、ICU滞留时长37.2(20.6,70)h,II组分别是14.5(7.5,21.4)h、45.2(20,93.9)h,I组患儿带管时间更短(P<0.05); I组中并发乳糜胸1例,II组中并发左侧气胸1例,两组均未见出血、死亡等并发症;余各项指标两组之间均差异无统计学意义。结论:对于狭窄段较短的患者可行主动脉端端吻合,而狭窄段较长,且狭窄内径不过窄可以选择左锁骨下动脉翻转补片成形术。

Objective: To evaluate the best procedure of non-extracorporeal circulation surgical treatment for constraction of aorta arch by retrospective study. Methods: clinical data of 80 patients who underwent surgical repair through left thoracotomy without extracorporeal circulation from June, 2009 to June, 2018 in our hospital was retrospectively analyzed. According to surgical strategies for reconstruction of aorta, patients were divided into two groups. 62 patients whom went through end-to-end repair were in group 1,age of 12.2(6.0,37.3)months, weight of(11±5.4)kg. 18 patients who underwent subclavian flap repair were in group 2, age of 18.7(8.5,35.7)months, weight of 10.8(7.4,14.2)kg. Medical records were reviewed for patient characteristics and outcomes, phone interview were performed afterwards. Results: The stenosis lesion length is(9.93±4.8)mm in group 1 and 15(10,20)mm in group 2, the inner diameter of stenosis lesion in group 1 is(2.84±0.49)mm,(3.33±0.59)mm in group 2. The degree of stenosis lesion in aorta has significant difference between two groups(P<0.05). There is no significant difference about ICU stays between two groups. The intubation time in group 1 is shorter than group 2 9(6.6,16.4)vs. 45.2(20,93.9)h(P<0.05). There is no post operational mortality, 1 case of chylothorax occurred in group 1, and 1 case of pneumothorax occurred in group 2. Conclusions: End-to-end anastomosis can be performed on shorter lesions of stenosis in coarctation of aorta. For those who have longer lesions and less narrow stenosis diameter, subclavian flap aortoplasty is preferred.