主动脉弓缩窄的外科治疗

目的：回顾和总结小儿主动脉弓缩窄（COA）的外科治疗经验。方法：自2008~2009年共手术治疗COA患儿14例,其中单纯COA 6例,合并心内畸形者8例。单纯COA采用左后外侧切口,而同时合并心内畸形者经正中切口一期矫治COA和心内畸形。矫治COA的方法主要有：缩窄段切除并端端吻合,左锁骨下动脉垂片成形术,补片扩大成形术。结果：14例患儿均存活,无肾功能衰竭、脊髓损伤等严重并发症。术后随访下肢血压高于上肢者10例,上下肢血压相仿者4例。结论：单纯COA手术可于3~5岁进行手术,而合并心内畸形者则尽早手术,一期根治术是安全和有效的。正中切口一期矫治COA及合并的心内畸形是可行的。根据病人缩窄段的具体情况,选择合适的矫治方法可以获得满意的疗效。

SURGICAL TREATMENT FOR COARCTATION OF AORTA

Objective：To sum up the experiences of surgical treatment for coarctation of aorta（COA）.Methods 14 patients were included.The types were isolated COA（n=6） and COAassociated with intracardia anomalies（n=8）.For isolated COA patients,the fourth left posterior lateral intercostals thoracotomy was used.Single-stage repair for the COA associated cardia anomalies was successfully performed via a midline sternotomy.The types of surgical procedures mainly included resection and direct end-to-end anastomosis,suclavian flap aortoplasty technique and synthetic patch aortoplasty.Results No patient died in the group,and there was no paraplegia,kidney failure.Patients were follow-up from 3 months to 36 months and the results were satisfactory.Blood pressure of lower extremity was higher（n=10） than upper extremity in 10,and 4 eases having the sovme bleod pressure in lower and upper xtremitiesConclusion We advocate early operation for the patient with COA associated with intracardia anomalies and for the patient with the isolated COA without symptom,the surgical treatment can be postponed to 3~5 years old.Single-stage repair of the COA associated cardia anomalied via a midline sternotomy is safe and effective.The choice of appropriate surgical procedure is crucial to the effect of the surgical treatment.