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目的探讨经胸骨正中切口一期矫治小儿主动脉缩窄(CoA)及合并畸形的手术方法和治疗效果。方法2002年6月至2005年8月手术治疗CoA及合并畸形36例,其中男27例,女9例;年龄18d~8岁,平均(14·3±9·5)个月,其中小于1岁27例,小于3月龄18例;体重3~23kg,平均(6·6±3·0)kg。有症状的婴儿型27例,无症状的大儿童型8例,经左胸切口矫治CoA后再狭窄1例;合并室间隔缺损、动脉导管未闭、房间隔缺损、主动脉弓发育不良、完全性大动脉转位及主动脉瓣下狭窄等心内畸形。36例均经胸骨正中切口以扩展端端吻合术一期矫治CoA及合并畸形。结果手术死亡1例,系术前反复心力衰竭及充血性肺炎,术后15d死于心肺功能衰竭。35例随访4~36个月,晚期死亡1例。生存34例恢复良好,无再缩窄发生。结论经胸骨正中切口一期矫治CoA及合并畸形效果良好;扩展端端吻合法是一种值得推荐的技术。
Objective To investigate the surgical treatment and treatment of pediatric aortic constriction (CoA) and deformity combined with a median sternotomy. Methods From June 2002 to August 2005, 36 cases of CoA and deformity were treated surgically, including 27 males and 9 females, aged from 18 days to 8 years (mean, 14.3 ± 9.5) months, of which less than 1 27 years old, less than 3 months old in 18 cases; body weight 3 ~ 23kg, an average of (6 6 ± 3 0) kg. Symptomatic infants in 27 cases, asymptomatic children in 8 cases, left thoracic incision of CoA restenosis in 1 case; combined ventricular septal defect, patent ductus arteriosus, atrial septal defect, aortic arch dysplasia, complete aorta Transposition and aortic valve stenosis and other heart deformities. Thirty - six cases were treated by the mid - incision of the sternum to extend the anastomosis of the anastomosis for the treatment of CoA and deformity. Results 1 case of surgical death, preoperative recurrent heart failure and congestive pneumonia, died of cardiopulmonary failure 15d after operation. 35 cases were followed up for 4 to 36 months, 1 died in late stage. Survival of 34 patients recovered well, no further narrowing occurred. Conclusion The results of one-stage correction of CoA and combined deformity by median sternotomy are good. The extended end-to-end anastomosis is a recommendable technique.