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目的回顾和总结小儿主动脉缩窄的外科治疗经验。方法66例患儿,年龄20d～8.5岁。21例单纯CoA,45例同时合并心内畸形。单纯CoA从左后外侧第4肋间进胸。若合并有心内畸形,早期9例患儿先左后外侧肋间进胸纠治CoA,再正面开胸体外循环下纠治心内畸形,2000年1月之后,35例采取正中劈开胸骨,体外循环下Ⅰ期纠治CoA和心内畸形。另有1例分期手术。纠治CoA方法主要有缩窄段切除行端端吻合或端侧吻合术,补片扩大成形术和左锁骨下动脉瓣翻转成形术。结果患儿术后早期下肢动脉血压超过上肢47例,与上肢相同13例,仍低于上肢6例,无一例发生肾功能衰竭和截瘫。死亡2例(1例死于严重心力衰竭,另1例死于心律失常)。随访39例,下肢动脉血压超过上肢34例,相同4例,1例伴有主动脉弓发育不良术后6个月仍存在缩窄(上肢血压高于下肢35mmHg)。3例有声音嘶哑,远期随访无高血压出现。结论单纯主动脉缩窄或合并心内畸形宜早期手术治疗,Ⅰ期根治术是安全和有效的。
Objective To review and summarize the experience of surgical treatment of pediatric aortic constriction. Methods 66 cases of children, aged 20d ~ 8.5 years old. 21 cases of simple CoA, 45 cases of simultaneous cardiac deformity. Simple CoA from the left posterolateral fourth intercostal space into the chest. If combined with intracardiac deformity, the early 9 cases of left anteromedial intercostal invasion into the chest to correct CoA, and then positive under cardiopulmonary bypass correction of intracardiac deformity, after January 2000, 35 cases were split in the middle of the sternum, Phase Ⅰ Coronary Artery Degeneration and CoA Under Cardiopulmonary Bypass. Another case of staging surgery. Correction CoA methods are mainly narrowing the segment resection line end anastomosis or anastomosis, patch enlargement and left subclavian valve flap angioplasty. Results In the early postoperative period, the arterial blood pressure of lower extremity was higher than that of the upper extremity in 47 cases, the same as the upper extremity in 13 cases, still lower than the upper extremity in 6 cases, and none of them had renal failure and paraplegia. 2 died (1 died of severe heart failure and the other died of arrhythmia). Follow-up was performed in 39 cases. Arterial blood pressure of the lower extremity exceeded that of the upper extremity in 34 cases and the same in 4 cases. One case was accompanied by an aortic arch dysplasia at 6 months postoperatively. The upper extremity blood pressure was 35 mmHg higher than the lower extremity. 3 cases had a hoarse voice, long-term follow-up without hypertension. Conclusions Aortic stenosis alone or combined with intracardiac deformity should be treated early, stage Ⅰ radical surgery is safe and effective.