电视胸腔镜下动脉导管钳闭与常规手术方法比较

目的 探讨电视胸腔镜下动脉导管未闭手术治疗的方法与效果。方法 将５０例动脉导管未闭患者分为电视胸腔镜组和常规手术组。电视胸腔镜组：２５例,采用２～３个钛夹钳闭;常规手术组：２５例,采用开胸结扎法处理未闭的动脉导管。结果 电视胸腔镜组术后均无残余分流,亦无喉返神经损伤等并发症,平均左心室内径和肺动脉内径较术前分别缩小１．０５ｃｍ和０．８１ｃｍ（Ｐ〈０．０１）;与常规手术组比较,明显地减轻了手术创伤,     

胸腔镜辅助下小切口手术治疗动脉导管未闭8例

胸腔镜辅助下小切口手术治疗动脉导管未闭 8例 ,手术获全成功 ,无死亡。本法优点创伤小 ,恢复快。     

电视胸腔镜下动脉导管钳闭86例

1995年 11月至 2 0 0 2年 6月 ,我们行改良的电视胸腔镜(ＶＡＴＳ)下动脉导管未闭 (ＰＤＡ)钳闭手术 86例 ,3例因术中探查见ＰＤＡ直径 >0 8ｃｍ而改常规剖胸手术。实际完成ＶＡＴＳ手术 83例 ,现总结、探讨其手术适应证、手术方法、并发症防治以及近期和远期手术效果 ,报道如下。临床资料　 83例中男 2 6例 ,女 5 7例 ;年龄 3个月～ 2 8岁。ＰＤＡ为管状型 6 3例 ,漏斗型 2 0例。ＰＤＡ平均直径(0 5 7± 0 18)ｃｍ。Ｘ线胸片示心胸比率 0 5 6± 0 0 5。心电图示左室扩大 5 3例。二维超声心动图测得术前左室内径(4 4 9± 1 12 )ｃｍ ,…     

经腋下小切口结扎小儿动脉导管未闭术

自1987年1月至1997年6月，经左腋下小切口行小儿动脉导管未闻结扎术37例，男14例，女23例，年龄2．0～13岁。管型27例，漏斗型10例。导管直径0．4～1．1cm，长度0．5～0．9cm。全组术野显露良好，手术顺利，手术时间86±18分，无大出血和手术死亡，无喉返神经损伤及残余分流。切口均甲级愈合，左上肢功能位时，看不到疤痕，术后住院时间8．1±1．4天。随访2个月～3年，无导管再通和胸廓畸形。认为左腋下小切口行小儿动脉导管未闻结扎术创伤小、简便、安全、美容效果好。     

12例电视胸腔镜下动脉导管未闭手术

１２例电视胸腔镜下动脉导管未闭手术李晓辉，郭斌，石静，崔洪伟，紫巍，耿建英电视胸腔镜外科是近年来发展起来的一个新领域，做为微手术外科正广泛应用于临床。我们自１９９４年３月～１０月采用此种方法为１２例动脉导管未闭（ＰＤＡ）病人施行手术治疗，效果满意。现...     

电视胸腔镜手术治疗动脉导管未闭

作者采用电视胸腔镜手术（ＶＡＴＳ）治疗２１例动脉导管未闭患者。除１例因重度肺动脉高压导管较粗、１例小血管出血转为开胸手术外，另１９例均手术恢复良好。术后１例出现可逆性喉返神经损伤，２例左胸腔少量积气，１例再通行二次ＶＡＴＳ手术，无严重手术并发症及死亡。均未放置引流管及输血，证实ＶＡＴＳ治疗ＰＤＡ是一安全可靠、创伤小、术后痛疼轻、恢复迅速的新方法，尤其适于儿童患者     

小切口未闭动脉导管结扎术

1998年 2月至 2 0 0 2年 4月 ,我们利用自制特殊器械作小切口未闭动脉导管结扎术 2 5例 ,效果良好 ,现报道如下。资料和方法　本组 2 5例中女 14例 ,男 11例 ;年龄 4～ 2 0岁 ;体重 8～ 5 5ｋｇ ;导管直径为 0 5～ 1 2ｃｍ。术中使用特制牵开器、引线器、深部打结器等器械 ,10 0Ｗ高亮度氙灯与外径为 3ｍｍ光导束小切口内照明。手术取右侧卧位 ,以肩胛下角为中点 ,沿第 6肋上缘作5～ 6ｃｍ切口 (切口相当于动脉导管在胸壁的投影 )。使用小切口牵开器暴露导管三角区 ,用导光束折成 90°角紧贴伤口边缘作深部照明 ,用弯柄解剖剪在主动脉侧显…     

电视胸腔镜手术治疗动脉导管未闭16例

目的探讨电视胸腔镜手术(VATS)治疗动脉导管未闭(PDA)的手术方法与效果。方法在电视胸腔镜下游离动脉导管,10例采用丝线结扎,然后用钛夹钳闭动脉导管;6例单纯采用钛夹钳闭动脉导管。结果全组16例术后无喉返神经损伤,无导管残余分流等并发症,平均住院时间7d。随访15例,超声心动图检查无导管再通。结论VATS治疗PDA操作简便、安全可靠、容易掌握和推广,具有创伤小、术后疼痛轻、出血少、恢复快及美观等优点。     

左腋下小切口动脉导管未闭结扎术

本报道经左腋下小切口径路行动脉导管未闭(Patent arterial duct，PDA)结扎手术16例。年龄5岁～22岁，平均9．8岁。切口5cm～6cm。手术时间60min～85min，平均72min。出血量20ml～100ml，平均50ml。术后胸腔引流量40ml～100ml，平均60ml。随访5月～40月，平均20月，无导管再通及动脉瘤形成，切口疤痕小。本法切口隐蔽，外观美观，创伤小，不影响肢体功能，安全有效。     

动脉导管未闭的外科治疗

目的 探讨动脉导管未闭合理手术方式。方法 总结外科治疗动脉导管未闭１１７例,其中合并肺动脉高压４２你,合并心血管病变３４例。经左后外侧切口结扎６９例,切断缝合１４例,经正中切口结扎５例,体外循环下修补２９例。结果 手术死亡１例,远期死亡１例,喉返神经损伤２例,无导管再通。结论 根据年龄,导管类型、粗细,合并肺动脉高压及心血管病变选择合适的手术方式,并严格掌握手术适应证,是治疗成功的关键。     

A video-assisted thoracoscopic surgical technique for interruption of patent ductus arteriosus

We describe herein a technique for patent ductus arteriosus (PDA) closure using a method of video-assisted thoracoscopic surgical (VATS) interruption derived from video-assisted endoscopic surgery. This technique of repair was performed on five patients with a mean age of 3 years and a mean weight of 13.7 kg during 1994 and 1995. Under general anesthesia, two 10-mm trocars and two or three 5-mm trocars were inserted through the left thoracic wall. A video camera and specially designed surgical tools including scissors, dissectors, and a clip applicator were then introduced. The ductus was dissected, and two titanium clips were applied to interrupt the ductus completely. Successful closure of the PDA by this video-assisted technique was achieved in all patients. The only complication which developed in one patient was hoarseness for 2 weeks postoperatively. The hospital stay ranged from 7 to 12 days and there were no serious complications of deaths. There results indicate that video-assisted thoracoscopic surgical interruption is a safe and effective technique for achieving closure of PDA.     

Thoracoscopic ligation versus coil occlusion for patent ductus arteriosus: A matched cohort study of outcomes and cost

BACKGROUND: Coil occlusion (CO) and video-assisted thoracoscopic surgery (VATS) have both emerged as minimal access therapies for patent ductus arteriosus (PDA). These techniques have not previously been statistically compared. METHODS: Twenty-four consecutive children undergoing VATS for PDA were each retrospectively matched by PDA diameter and child weight to two children undergoing CO (total 48) during the same time period. The two modalities were compared with respect to outcome and cost. Statistical analysis was performed using a Student's t-test and Mantel-Haenszel relative risk. Cost analysis from an institutional perspective was used to compare resource consumption. RESULTS: Mean PDA diameter was 3.6 +/- 1.2 mm in both groups. Mean age and weight for VATS and CO children were 2.7 and 2.9 yrs and 13.2 and 13.1 kg, respectively. Mean surgical times were 94 +/- 34 min for VATS and 50 +/- 23 min for CO (p < 0.0001). Mean length of stay was 1.6 +/- 0.2 days for VATS and 0.6 +/- 0.2 days for CO (Mantel-Haenszel RR (95% CI) = 0.15 [0.07, 0.29], p < 0.0001). Mean fluoroscopy time with CO was 13 +/- 7 min. No VATS or CO children required conversion to open surgical ligation. Two children in each arm (8% VATS, 4% CO) required indefinite antibiotic endarteritis prophylaxis for a persistent shunt. The cost per child was C$ 4282.80 (Canadian dollars) for VATS and C$ 3958.08 for CO. CONCLUSIONS: VATS is as efficacious for PDA closure as CO but requires longer surgical times and lengths of stay. Costs for each procedure are similar.     

Transoesophageal echocardiography detects residual ductal flow during video-assisted thoracoscopic patent ductus arteriosus interruption

This report describes transoesophageal echocardiographic (TEE) monitoring in a one-year-old boy undergoing patent ductus arteriosus (PDA) interruption. After application of a first vascular clip, echocardiographic monitoring detected incomplete interruption of ductal flow, prompting the surgeon to add a second clip to the ductus. The procedure was performed via a new surgical technique: video-assisted thoracoscopic surgery (VATS). This innovative approach offers many advantages to patient care including reduced postoperative pain and better preservation of pulmonary function. We conclude that the use of TEE monitoring during PDA interruption via the VATS procedure may improve the surgical result, and eliminate reintervention and the complications associated with residual ductal flow.     

Anaesthesia for video-assisted thoracoscopic patent ductus arteriosus ligation

The case notes of children undergoing video-assisted thoracoscopic ligation of a patent ductus arteriosus were reviewed with particular emphasis on the anaesthetic management. All children were managed using one-lung ventilation with no serious adverse sequelae. The lungs could be isolated easily in all cases and no special equipment was required. We describe our initial series of 13 cases and discuss the anaesthetic implications arising from this surgical technique. We also discuss the different ways of monitoring duct closure.     

Esophageal stethoscope: an old tool with a new role, detection of residual flow during video-assisted thoracoscopic patent ductus arteriosus closure

Background

Video-assisted thoracoscopic surgery (VATS) has emerged as an innovative and popular procedure for closure of a patent ductus arteriosus (PDA), but is associated with a minute rate of residual or recurrent duct patency. This study aims to analyze the efficacy of intraoperative esophageal stethoscopic monitoring in reducing the incidence of residual ductal flow during PDA clipping by VATS.

Methods

Between June 1997 and October 2009, we retrospectively assessed 2000 consecutive patients with PDA who underwent VATS. During the procedure, heart sounds were monitored by the anesthesiologist through an esophageal stethoscope. Changes in continuous cardiac murmurs were recorded before and after the PDA clipping and were confirmed to disappear completely. Color flow Doppler echocardiography was performed immediately before discharge, and patients were followed monthly for 3, 6, and 12 months and then annually to confirm the absence of residual or recurrent shunt.

Results

Mean age was 6.0 years (range, 1 month-35 years), mean weight was 11.1 kg (range, 6-65 kg), and mean PDA diameter was 5.5 mm (range, 3-9 mm). Ninety-two percent of patients showed no ductal flow after a single clipping. In the other 8% of patients, residual flow was detected intraoperatively after a single clipping, but was eliminated by the second clipping. Twelve patients (0.6%) presented with residual ductal flow immediately after the operation (detected by color Doppler echocardiography), which was eliminated by thoracotomy before discharge. All patients left the hospital with echocardiography documenting no evidence of residual PDA. At follow-up, the incidence of residual patency was 0.2% (4 of 2000).

Conclusions

Our results demonstrate that the intraoperative esophageal stethoscope provides a remarkably effective technique for monitoring and evaluating PDA ligation by VATS, thus avoiding reintervention and the complications associated with residual ductal flow in most cases.     

Video-thoracoscopic surgical interruption of patent ductus arteriosus. Routine experience in 332 pediatric cases

Objective: Pediatric video-assisted thoracic surgery closure of patent ductus arteriosus can now be performed on a routine basis. We review here our entire experience with this technique. Methods: Three hundred and thirty two consecutive patients underwent video-assisted closure of patent ductus arteriosus from September 1991 to September 1996. Indications were symptomatic ductus or failure of closure in older children. All complications were carefully noted, as well as intensive care unit stay, and operating room time. Results: Patients were divided in three age groups: less than 6 months (101 patients, 31%), 6–48 months (179 patients, 54%), greater than 48 months (52 patients, 16%). The mean weight was 12.6 kg (range 1.2–65 kg). Associated cardiac anomalies were atrial septal defect (3), ventricular septal defect (5), anomalous pulmonary venous return (1). Six patients had a residual shunt following video-assisted interruption. Five patients had successful immediate clip repositioning (three via video-assisted interruption, two via thoracotomy). One patient continued to have a small shunt, which is followed medically. Complications included recurrent laryngeal nerve dysfunction in six patients (1.8%) (five transient, one persistent). Mean operating time was 20±1.5 mn and hospital stay averaged 48 h (>6 months), 72 h (<6 months). Conclusions: Interruption of patent ductus can be safely performed by video-assisted technique with minimal morbidity and no mortality. It can be performed in all age group with minimal hospital stay.     

Ligation cum division-suture of patent ductus arteriosus

Objective To describe a combined ligation cum division-suture technique for closure of patent ductus arteriosus. Technique The ductus is isolated using hypotensive anaesthesia. A single clamp is applied at the aortic end. The pulmonary arterial end is ligated. Another ligature transfixes the ductus. A mattress suture is passed through the aortic end. The ductus is now divided. The aortic end is closed using a second row of over and over sutures. Conclusion Single clamp technique for ligation cum division-suture of patent ductus is simple and safe. (Ind J Thorac Cardiovasc Sure, 2001; 17:258-259)     

超声诊断右位动脉导管未闭1例

患者男,17岁,主因＂活动后心悸、气促＂入院。查体：心尖搏动增强并向左下移位,心浊音界向左下扩大,于胸骨左缘第2肋间可闻及响亮的连续性机器样Ⅳ级杂音,并向左锁骨下窝传导。超声：左心房、左心室扩大;大血管短轴切面示主肺动脉及右肺动脉增宽,右肺动脉根部与降主动脉间可见管道相通,右肺动脉侧管口直径8mm,主动脉侧管口直径12 mm.     

高位硬膜外麻醉在婴幼儿动脉导管未闭手术中的应用

目的 观察高位硬膜外麻醉在婴幼儿动脉导管未闭（ＰＤＡ）手术中的应用,方法 全部患儿全麻插管后,均采用高全硬膜外麻醉,穿刺部位选择在Ｔ７－８或Ｔ８－９,阻滞药物为利多卡因和丁哌卡因混合液,患儿术后拔管,观察动脉导管结扎前后的心血管反应。结果辅以小剂量（０．５－０．１）％的吸入性全麻药,降压平稳,阻断前的ＳＰ,ＤＰ,ＭＡＰ与硬膜外前比较有显著性差异,阻断ＰＤＡ后血压缓慢上升,结论 高位硬膜外麻醉使心