婴幼儿主动脉缩窄合并主动脉弓发育不良的外科治疗策略

Surgical treatment of aortic coarctation complicated with aortic arch hypoplasia in infant

目的探讨婴幼儿主动脉缩窄合并主动脉弓发育不良的手术疗效,为优化临床外科治疗策略提供参考依据。方法回顾分析本院49例主动脉缩窄伴主动脉弓发育不良患儿临床资料,年龄0.57~36(4.69±5.46)月。全组手术均在中低温体外循环低流量脑灌注下完成,根据矫治方法分3组:为补片加宽组(n=6例),扩大端侧吻合组(n=19例),主动脉滑动成形组(n=24例)。记录体外循环时间、低流量脑灌注时间、ICU监护时间、上肢与下肢有创血压压差(术前、术后24h)、彩色多普勒跨缩窄段峰值压差(术前、术后1周、末次随访)、术后死亡率和再狭窄率等指标进行统计学分析。结果各组间性别、体重、年龄、低流量脑灌注时间、体外循环时间、ICU时间无统计学差异(P>0.05)。各组术前有创及彩超压差无明显差异(P>0.05),术后较术前均明显降低(P<0.05)。扩大端侧吻合和滑动成形组术后残余压差、手术死亡率以及随访再狭窄率均无明显差异(P>0.05),但均低于补片加宽组(P<0.05)。结论目前常用各种手术方法均可有效治疗婴幼儿主动脉缩窄合并主动脉弓发育不良,主动脉弓滑动成形和扩大端侧吻合法疗效更佳,应尽量避免应用补片加宽术。

Objective To explore the surgical effect of aortic coarctation complicated with aortic arch hypoplasia,and to pro⁃vide reference for the optimization of clinical surgical treatment strategies.Methods The clinical data of 49 infants with aortic coarcta⁃tion and aortic arch dysplasia aged 0.57-36(4.69±5.46)months were retrospectively analyzed.All the operations were performed un⁃der low-flow cerebral perfusion and moderate hypothermic extracorporeal circulation(ECC).They were divided into 3 groups according to the correction method:patch widening group(n=6 cases),extended end-to-side anastomosis group(n=19 cases)and aortic arch sliding aortoplasty group(n=24 cases).The time of ECC,the time of low-flow cerebral perfusion,the time of ICU stay,the invasive blood pressure gradient between upper and lower limbs(before and 24 h after surgery),the color Doppler peak pressure gradient across coarctation(preoperative,one week postoperative,last follow-up),the postoperative mortality and restenosis rate were recorded and statistically analyzed.Results There were no statistical differences in gender,weight,age,low-flow cerebral perfusion time,ECC time and ICU time among all groups(P>0.05).There were no significant differences in invasive and color ultrasound pressure gradient among all groups before surgery(P>0.05),but significantly decreased after surgery(P<0.05).There were no significant differences in postoperative residual pressure gradient,operative mortality and follow-up restenosis rate between the extended end-to-side anastomosis group and the aortic arch sliding aortoplasty group(P>0.05),but they were lower than those in the patch widening group(P<0.05).Conclusion At present,various commonly used surgical methods can effectively treat infantile aortic coarctation combined with aortic arch hypoplasia.Aortic arch sliding aortoplasty and extended end-to-side anastomosis are more effective,and the application of patch widening should be avoided as far as possible.