一期手术矫治复杂型主动脉缩窄15例临床分析

One-stage operation in the treatment of complex aortic coarctation: A clinical analysis of 15 cases

目的总结复杂型主动脉缩窄的临床特点和外科治疗经验。方法回顾性分析2010年1月至2017年6月经超声心动图及CT血管造影确诊、采用一期手术矫治的15例复杂型主动脉缩窄患者的临床资料。患者均在体外循环下先行心内畸形矫治,然后采用选择性脑灌注或者深低温停循环,切除缩窄段后端端吻合术矫治主动脉缩窄,本组患者弓部-降主动脉直接吻合7例,升主动脉-降主动脉人工血管旁路5例,升主动脉-腹主动脉人工血管旁路2例,缩窄段人工血管补片扩大成形1例。分析其临床表现、治疗方法及转归。结果手术经过顺利,术后早期死亡1例,死于心力衰竭;因术野渗血多延迟关胸1例;术后二次开胸手术止血1例;透析1例。14例均获得随访,随访时间11个月至8年,平均随访49个月。患者上、下肢血压差均小于20 mm Hg(1 mm Hg=0.133 kPa),2例成人患者术后需长期服用抗高血压药,超声心动图和CT血管造影检查显示人工血管血流通畅,吻合口无假性动脉瘤形成。结论根据复杂型主动脉缩窄患者的临床特点,选择个体化的治疗方案,一期手术安全、有效。

Objective To summarize the clinical characteristics and surgical treatment experience of complex aortic coarctation.Methods The clinical data of 15 patients with complex coarctation of aorta who were diagnosed by echocardiography and CT angiography from January 2010 to June 2017 were retrospectively analyzed.All patients underwent cardiac malformation correction under cardiopulmonary bypass,and then underwent selective cerebral perfusion or deep hypothermic circulatory arrest,resection of the constricted segment and posterior end-to-end anastomosis to correct aortic coarctation.There were 7 cases of direct arch-descending aorta anastomosis,5 cases of ascending aorta-descending aorta bypass,2 cases of ascending aorta-abdominal aorta bypass and 1 case of enlarged angioplasty with constricted aortic patch.The clinical manifestations,treatment methods and prognosis were analyzed.Results The operation proceeded smoothly,1 case died of heart failure in the early stage after operation,1 case of delayed chest closure due to bleeding in operation field,1 case of hemostasis after second thoracotomy and 1 case of dialysis.All 14 cases were followed up for 11 months to 8 years,with an average of 49 months.The difference of blood pressure between upper and lower limbs was less than 20 mm Hg.Two adult patients needed to take antihypertensive drugs for a long time after operation.Echocardiography and CT angiography showed that the artificial blood flow was smooth and no pseudoaneurysm was found at the anastomotic site.Conclusion Individualized treatment should be selected according to the clinical characteristics of patients with complex aorta coarctation,and one-stage operation is safe and effective.