新鲜自体心包片在婴幼儿主动脉弓补片成形术的经验探讨

Experience of Fresh Autologous Pericardium for Aortic Arch Patch Plasty in Infants

目的探讨新鲜自体心包片在婴幼儿主动脉弓补片成形术的外科治疗经验,为临床治疗提供更合理的手术方法。方法回顾性分析2018年6月至2019年10月12例应用新鲜自体心包片进行主动脉弓成形的患儿资料,分析比较患儿术前、术后及近中期随访的结果。结果12例患儿均在体外循环下完成主动脉弓补片成形术,9例为主动脉缩窄合并弓发育不良,3例为主动脉弓中断,平均体外循环时间为(125.1±38.5)min,平均下半身停循环时间为(33.5±6.1)min,术后早期无患儿死亡,9例主动脉缩窄合并弓发育不良患儿术后早期超声估测主动脉弓降部处平均峰值压差为(14.3±4.9)mmHg,较术前[(46.3±15.2)mmHg]显著降低(P<0.05);3例主动脉弓中断患儿术后早期超声提示主动脉弓降部血流通畅。12例患儿均完成随访,平均随访时间为(8±4.3)个月,随访期间无患儿死亡,无主动脉瘤样扩张、左主支气管压迫、膈肌麻痹及神经系统等并发症;12例患儿随访期间超声提示主动脉弓降部血流通畅,平均峰值压差为(10.3±3.6)mmHg。结论新鲜自体心包片是主动脉弓补片成形术比较理想的材料,术后近中期结果满意,但是远期结果有待进一步随访观察。

Objective To explore the treatment experience of fresh autologous pericardium for aortic arch patch plasty in infants and to provide a better surgical choice in clinical practice.Methods A total of 12 infants undergoing aortic arch patch plasty with fresh autologous pericardium in our hospital from June 2018 to October 2019 were retrospectively studied.The results of preoperative,postoperative and mid-term follow-up were analyzed and compared.Results All the 12 patients underwent aortic arch patch plasty under cardiopulmonary bypass,9 infants with aortic coarctation combining hypoplastic arch,and 3 infants with interrupted aortic arch.The mean cardiopulmonary bypass time was(125.1±38.5)min and the mean lower body circulatory arrest time was(33.5±6.1)min.There was no death after the operation.The mean peak pressure gradients after the operation of the 9 infants with aortic coarctation combining hypoplastic arch was significantly lower than that before the operation[14.3±4.9]vs[46.3±15.2]mmHg(P<0.05).The normal blood flow were restored after operation in 3 infants with interrupted aortic arch.Follow-up was conducted in all the 12 patients with an average period of(8±4.3)months.During the follow-up period,there was no death and no complication such as aortic aneurysmal dilatation,left main bronchial compression,phrenic muscle paralysis or nerve injury.The normal blood flow were restored during followup in all the patients,and the mean peak pressure gradients was(10.3±3.6)mmHg.Conclusions Fresh autologous pericardium is an ideal material for aortic arch patch plasty in infants.The short-term and mid-term results are satisfactory,but the long-term results needs further follow-up.