先天性双主动脉弓微创外科治疗

Minimally invasive surgical technique for the treatment of congenital double aortic arch

目的总结先天性双主动脉弓(double aortic arch,DAA)行腋下纵行小切口手术治疗效果。方法回顾性分析中国医学科学院阜外医院小儿心脏外科中心2016年10月—2021年8月行腋下纵行小切口手术治疗DAA患儿的临床资料。结果共纳入15例患儿,其中男11例、女4例,年龄3~61(20.00±18.80)个月,包括8例DAA和7例DAA合并左主动脉弓中断伴纤维连接患儿。13例患儿采用左腋下纵切口路径;2例患儿采用右腋下纵切口路径,其中1例患儿因合并膜周型室间隔缺损,经右腋下纵切口在体外循环下同期行修补手术。所有患儿均顺利完成手术,梗阻症状明显缓解,未出现与手术相关并发症及围手术期死亡病例。手术时间30~192(61.93±40.19)min,术后呼吸机支持时间2~9(5.33±2.53)h,ICU停留时间18~124(51.00±38.07)h,总住院时间8~21(12.67±3.42)d。中位随访时间6(3,9)个月,患儿症状基本消失,生长发育正常。结论腋下纵行小切口手术治疗DAA是一种安全、有效且美观的手术路径。

Objective To summarize the treatment results of double aortic arch(DAA)by minimally invasive surgical technique.Methods We retrospectively analyzed the clinical data of DAA patients who underwent minimally invasive surgeries in our center between October 2016 and August 2021.Results There were 11 males and 4 females with a mean age of 3-61(20.00±18.80)years.There were 8 patients of DAA and 7 patients of DAA complicated with distal leftsided aortic arch atresia and ligamentum connection.All patients received operations through minimal subaxillary incision,13 patients were through left side and 2 patients were through right side.One patient with ventricular septal defect was performed operations concurrently under the cardiopulmonary bypass through right minimal subaxillary incision.All patients had symptom improvement without surgery related complications or death in postoperative period.The duration of operation was 30-192(61.93±40.19)min and mechanical ventilation time was 2-9(5.33±2.53)h.The length of ICU stay was 18-124(51.00±38.07)h and hospital stay time was 8-21(12.67±3.42)d.All patients had symptomatic relief with good growth and exercise tolerance during the follow-up of 6(3,9)months.Conclusion Minimally invasive surgical technique is a safe,effective and cosmetic approach with good results for DAA treatment.