儿童先天性漏斗胸合并先天性心脏病的同期手术治疗策略探讨

Simultaneous surgical strategy for pectus excavatum and concurrent congenital heart defects in children

目的探讨儿童先天性心脏病(congenital heart disease,CHD)合并漏斗胸最佳的治疗策略。方法回顾性分析2007年7月到2018年5月间于湖南省儿童医院住院治疗的17例先天性CHD合并漏斗胸患儿的资料,男10例,女7例,年龄(4.5±2.7)岁,年龄范围1~12.7岁,体重(14.5±5.2)kg,体重范围7.5~27.5 kg。其中单纯室间隔缺损4例,单纯房间隔缺损8例,室间隔缺损合并房间隔缺损3例,室间隔缺损合并房间隔缺损、动脉导管未闭1例,室间隔缺损合并肺动脉高压1例。根据年龄及漏斗胸程度,分别接受游离提拉胸骨、自制胸骨抬举装置、NUSS钢板的治疗,CHD分别接受体外循环下心内直视手术(经胸骨正中切口或右腋下直切口)或经皮及经心导管封堵治疗。结果17例患儿均接受同期手术矫治,心内畸形矫治及漏斗胸均矫治成功,住院时间(13.2±4.8)d,住院时间范围为(8~25)d。有2例切口延期愈合,1例术后左侧少量胸腔积液,无手术死亡、大出血及胸腔脏器损伤、排异反应等并发症。结论依据患儿的特点,选择个体化的方案予以同期矫治儿童CHD合并漏斗胸,可避免多次手术、麻醉的风险,安全有效。

Objective To explore the optimal surgical strategy for children with pectus excavatum(PE)and concurrent congenital heart defect(CHD).Methods From July 2007 to May 2018,retrospective reviews were conducted for medical records of 17 children undergoing simultaneous repair of PE with concurrent CHD.There were 10 boys and 7 girls with an average age of(4.5±2.7)(1-12.7)years and an avergae body weight of(14.5±5.2)(7.5-27.5)kg.There were simple ventricular septum defect(VSD,n=4),simple atrial septum defect(ASD,n=8),VSD&ASD(n=3),VSD&ASD&patent ductus arteriosus(PDA,n=1)and VSD with pulmonary hypertension(n=1).For repairing PE,open sternal elevation was performed with liberating tissue from posterior sternum,lifting sternum by wires,Nuss plating and a custom-made sternal lifting device.CHD was corrected by open heart surgery via cardiopulmonary bypass or transcatheter closure under echocardiography or radiology-guided percutaneous intervention.Results Among them,the operations led to satisfactory repair of both conditions without serious complications.All parents and children were satisfied with postoperative chest appearances.The mean duration of hospitalization was(13.6±4.8)(8-25)days.The postoperative complications were delayed wound healing(n=2)and minimal left pleural effusion(n=1).There was no occurrence of such severe complications as surgical mortality,major hemorrhage,chest organ injuries or implant rejection.Conclusions According to the characteristics of patients,individualized approaches are selected for correcting PE and concurrent CHD.Both safe and effective,such a strategy avoids the risks of multiple operations and anesthesia and the outcomes are satisfactory.