应用可吸收聚左旋乳酸微骨板外固定术治疗先天性心脏病合并支气管软化-单中心经验总结

External Fixation With Absorbable Poly-L-lactic acid Microplate to Treat Bronchomalacia Combined With Congenital Heart Disease

目的:总结应用可吸收聚左旋乳酸(PLLA)微骨板外固定术治疗先天性心脏病(先心病)合并支气管软化患儿的经验。方法:回顾性分析2017年12月至2019年1月,在我中心接受可吸收PLLA微骨板外固定术治疗先心病合并支气管软化的患儿8例,其中男性2例,女性6例。平均年龄(8.4±4.1)个月,平均体重(6.5±1.2)kg。观察术后机械通气时间、重症监护病房(ICU)时间、呼吸系统并发症等评估治疗效果。并于术后1、3、6、12个月复查超声心动图和胸部CT。结果:8例患儿中7例成功接受同期心脏畸形矫治和支气管可吸收PLLA微骨板外固定术,1例成功接受单纯支气管可吸收PLLA微骨板外固定手术。全组无围术期死亡,术后呼吸机辅助时间(24.4±23.7)小时,ICU时间(3.8±3.8)天。平均随访时间(6.5±6.2)个月,超声心动图显示所有患者心脏畸形矫治满意,CT显示支气管通畅。结论:采用可吸收PLLA微骨板外固定术治疗先心病合并支气管软化简便易行,治疗效果明显,可显著缩短机械通气时间及ICU时间,降低费用。近期效果满意。

Objectives:To summarize the experience of treating congenital heart disease complicating with bronchomalacia by external fixation of absorbable Poly-L-lactic acid(PLLA)microplate.Methods:Clinical data of 8 patients(2 males and 6 females)with congenital heart disease and bronchomalacia,who were treated with external fixation of absorbable PLLA microplate for bronchomalacia in our center from December 2017 to January 2019 were retrospectively analyzed.The average age was(8.4±4.1)months,and the average weight was(6.5±1.2)kg.Mechanical ventilation time,ICU time and respiratory complications were observed.Echocardiography and chest CT were performed at 1,3,6 and 12 months after the operation.Results:Seven out of the 8 patients were successfully treated with simultaneous cardiac malformation correction and external fixation of bronchus with absorbable PLLA microplates,and 1 patient was successfully treated with external fixation of bronchus with absorbable PLLA microplate.There was no perioperative death.The postoperative ventilator-assisted time was(24.4±23.7)hours,and the ICU time was(3.8±3.8)days.The mean follow-up time was(6.5±6.2)months.Echocardiography revealed successful correction of cardiac malformation,and CT showed that the bronchus was unobstructed.Conclusions:External fixation with absorbable PLLA microplates is feasible and effective in the treatment of congenital heart disease with bronchomalacia,which can significantly shorten the time of mechanical ventilation and ICU,and reduce the cost.Short-term results are satisfactory in this patient cohort.