胸腔镜治疗婴幼儿双主动脉弓畸形

Thoracoscopic management of double aortic arch malformation in infants

目的总结婴幼儿双主动脉弓畸形胸腔镜治疗效果.方法2015年1月至2019年5月,共收治10例双主动脉弓畸形患儿,男7例,女3例;年龄2h^8个月,9例右弓优势,1例左弓优势.出生前孕期35周行MRI检查了解血管环与气管、食管关系,气管压迫>1/3即采取出生后产时手术,压迫<1/3的出生后6个月左右进行手术治疗.结果10例均采用胸腔镜手术,1例因氧饱和度无法维持,中转开胸手术.手术时间80~135 min,平均100 min.术中出血5~10 ml.术后呼吸机支持时间4~14天.1例患者因经济原因放弃治疗外其余均治愈出院.术后随访1~6个月,无进食困难,无呼吸困难需再次手术者.4例需要呼吸机支持>7天,2例出现气胸,引流后治愈.1例出现声音嘶哑.结论产检可提高双主动脉弓畸形诊断率,小儿外科提前介入随访可减少患儿相关并发症发生,采用胸腔镜矫治畸形手术可行,对患者创伤小,伤口美观.

Objective To summarize the effect of thoracoscopy for infants with double aortic arch malformation.Methods The clinical data of 10 infants with double aortic arch malformation from January 2015 to May 2019 were retrospectively summarized,including 7 boys and 3 girls aged from 2 hours to 8 months,9 with right arch dominance and 1 with left arch dominance.MRI examination was performed at 35 weeks before birth to understand the relationship between vascular ring and trachea and esophagus.Postnatal surgery was performed when trachea compression exceeded one third,and selective operation was performed around six months after birth if the compression was less than one third.Results All the 10 cases underwent thoracoscopic surgery,and 1 case underwent thoracotomy because oxygen saturation could not be maintained.The operation time was 80—135 minutes,with an average of 100 minutes.Intraoperative bleeding was about 5—10 ml.Postoperative ventilator support time was 4-14 days.1 patient was cured and discharged except that he gave up treatment for economic reasons.Postoperative follow-up period was 1—6 months.No difficulty in eating,no difficulty in breathing required tracheal stenosis surgery again.4 patients needed ventilator support for more than 7 days,2 patients developed pneumothorax and were cured after drainage.One patient presented hoarseness.Conclusion Prenatal examination can improve the diagnosis rate of double aortic arch deformity,early intervention follow-up in pediatric surgery can reduce the incidence of related complications in children,and thoracoscopic surgery is feasible to correct the defbnnity,with small trauma and Less bleeding.