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目的:回顾总结主动脉弓中断经胸骨正中切口一期矫治的方法、疗效。方法:8例患者中,男性5例,女性3例,手术年龄1~11岁,体重9~21kg。其中A型7例,B型1例,8例均合并其他心血管畸形和重度肺动脉高压,均经正中胸骨切口一期矫治。结果:全组死亡1例,死于术后严重低心排综合征及肾功能衰竭,随访6例,6~14年,无晚期死亡。其中1例术后12年发生同种血管钙化、狭窄,压差12kPa,再次行人工血管连接升主动脉至腹主动脉旁路移植术,1例主动脉吻合口压差5.3kPa,其余主动脉吻合口压差为1.3~3.3kPa,心功能NYHAⅠ级。结论:主动脉弓中断经胸骨正中切口一期手术矫治尤其是主动脉直接吻合的方法操作简便,暴露良好,创伤小,有利于术后恢复。
Objective: To review and summarize the aortic arch interrupted by a median sternotomy treatment, efficacy. Methods: Among the 8 patients, there were 5 males and 3 females. The operative ages ranged from 1 to 11 years and the weights ranged from 9 to 21 kg. Of which type A in 7 cases, type B in 1 case, 8 cases were combined with other cardiovascular malformations and severe pulmonary hypertension, were corrected by a median sternal incision. Results: All the patients died in one case, died of severe low cardiac output syndrome and renal failure. Six patients were followed up for 6-14 years without advanced death. Among them, allograft calcification, stenosis and pressure difference of 12kPa occurred in one case at 12 years postoperatively. The ascending aorta was connected to the ascending aorta again to the abdominal aorta bypass graft. The pressure of the anastomotic anus was 5.3kPa and the other aorta Anastomosis pressure was 1.3 ~ 3.3kPa, cardiac function NYHA Ⅰ level. Conclusion: The aortic arch interrupted by a sternotomy incision surgery, especially aortic direct anastomosis method is simple, good exposure, less trauma, is conducive to postoperative recovery.