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目的比较婴儿主动脉缩窄(CoA)合并心内畸形一期矫治手术中采用端-侧吻合技术与扩大的端-端吻合技术的临床效果。方法 2008年1月至2011年7月广州市妇女儿童医疗中心共63例婴儿CoA合并心内畸形行一期矫治手术,按主动脉重建时的技术方法不同将63例患者分为两组,端-端吻合组:24例,男17例,女7例;年龄(4.6±2.9)个月,应用扩大的端-端吻合技术行手术治疗;端-侧吻合组:39例,男24例,女15例;年龄(3.4±2.6)个月,应用端-侧吻合技术行手术治疗。比较两组患者术后早期上、下肢动脉收缩压压差和围术期相关并发症发生情况。结果端-侧吻合组新生儿比率(23.1%vs.4.2%;χ2=3.979,P=0.045)、术前24 h内酸中毒比率(15.4%vs.0%;χ2=4.080,P=0.048)均高于端-端吻合组。术后端-端吻合组无死亡,端-侧吻合组死亡1例(2.6%)。端-侧吻合组术中停循环时间明显短于端-端吻合组[(18.6±2.7)min vs.(23.4±3.7)min,F=14.617,P=0.000]。端-端吻合组入心脏监护室(CICU)时上、下肢动脉收缩压压差<5 mm Hg、5～15 mm Hg、>15 mm Hg患者分别占20.8%、45.8%和33.3%,端-侧吻合组分别占97.4%、2.6%和0%,两组间差异有统计学意义(χ2=40.380,P=0.000)。术后24 h端-端吻合组上、下肢动脉收缩压压差<5 mm Hg、5～15 mm Hg、>15 mm Hg患者分别占45.8%、41.7%和12.5%,而端-侧吻合组占100%、0%和0%,两组间差异有统计学意义(χ2=26.620,P=0.000)。随访62例,随访时间2～36个月,所有患者均无血管瘤形成,无需再次手术处理的主动脉再狭窄。结论在婴儿CoA合并心内畸形的一期矫治手术中,与扩大的端-端吻合技术相比较,应用端-侧吻合技术可以安全、有效地显著降低术后早期出现的残余梗阻。
Objective To compare the clinical effects of end-to-side anastomosis with enlarged end-to-end anastomosis in the first-stage correction of infantile aortic constriction (CoA) with intracardiac deformity. Methods From January 2008 to July 2011, 63 infants with CoA with intracardiac deformity underwent an operation in Guangzhou Women’s and Children’s Medical Center. According to the technical method of aortic reconstruction, 63 patients were divided into two groups. - end anastomosis group: 24 cases, 17 males and 7 females; the age was (4.6 ± 2.9) months, and the patients were treated with enlarged end-to-end anastomosis; Female 15 cases; age (3.4 ± 2.6) months, the application of end-side anastomosis surgery. The systolic pressure difference and perioperative complications of the upper and lower extremities were compared between the two groups after operation. Results The ratio of neonates with end-to-side anastomosis (23.1% vs.4.2%; χ2 = 3.979, P = 0.045), acidosis within 24 hours before operation (15.4% vs.0%; χ2 = 4.080, Are higher than the end - anastomosis group. There was no death in the end-to-end anastomosis group and 1 death in the end-to-side anastomosis group (2.6%). The duration of circulatory arrest was significantly shorter in the end-to-side anastomosis group than in the end-to-end anastomosis group (18.6 ± 2.7 min vs. 23.4 ± 3.7 min, F = 14.617, P = 0.000). End-to-end anastomosis group into the cardiac care unit (CICU), upper and lower limb artery systolic pressure <5 mm Hg, 5 ~ 15 mm Hg,> 15 mm Hg patients accounted for 20.8%, 45.8% and 33.3% There was significant difference between the two groups (χ2 = 40.380, P = 0.000). The systolic pressure difference of lower and upper extremities was 45.8%, 41.7% and 12.5% respectively in the end-to-end anastomosis group at 24 hours after operation, while the patients with 5-15 mm Hg, 15-15 mm Hg and 12.5% Accounting for 100%, 0% and 0%, the difference between the two groups was statistically significant (χ2 = 26.620, P = 0.000). Sixty-two follow-up cases were followed up for 2 to 36 months. All patients had no hemangiomas and did not require reoperation of aortic restenosis. Conclusion In the first stage of correction surgery for infant with CoA complicated with heart deformity, the application of end-to-side anastomosis can reduce the residual obstruction in the early postoperative period safely and effectively compared with the enlarged end-to-end anastomosis.