42例动脉导管未闭外科治疗

目的 回顾分析42例动脉导管未闭外科（patent duct arterious，PDA）治疗效果。方法 ①单纯PDA或同时合并心内畸形，动脉导管小～中，可采用左前或左后外侧胸切口或胸部正中切口结扎（30例单纯PDA，3例合并心内畸形）；②动脉导管粗大、钙化或同时合并其他心内畸形，胸部正中切口体外循环（cardiopulmonary　bypass，CPB）下经肺动脉切口闭合（9例）；③同期或分期矫治心内畸形。结果术中死亡1例（死于低心输出量综合征）。其他手术并发症包括小量残余分流2例、短暂声音嘶哑2例、乳糜胸2例。除2例残余分流病例外，其余病例无导管再通，心功能明显改善，痊愈出院。结论单纯结扎简便易行，适用于大多数病例：导管粗大、重度肺动脉高压、怀疑有动脉内膜炎、钙化、合并其他心内畸形病例，应采用CPB（结合深低温、低流量）下缝闭，以策安全。

Surgical treatment of patent duct arterious: report of 42 cases

Objectives To review the surgical treatment results of forty-two patients with patent duct arterious (PDA).Methods Patients with small to moderate PDA underwent simply ligaton via a left anterior or left posterior thoroctomy (30 cases of isolated PDA)or median sternotomy (3 cases having associated cardiac anomaly) respectively. Patients with large or calcified PDA, with or without associated cardiac anomaly, were treated by closing from withing the pulmonary artery, with the aid of cardiopulmonary bypass (CPB) and deep hypothermia (9 cases). The complicated cardiac anomaly were total corrected by one-stage or two-stage treatment.Results One patient died of low-cardiac-output syndrome intra-operatively, the other surgical complications including residual shunt(2 cases) ,left recurrent laryngeal nerve injury (2 cases), and chylothorax (2 cases).Cardiac function were improved significantly in all but 2 cases. They were satisfactorily discharged from hospital. Conclusions PDA might be closed successfully with simply duct ligation for most patients, but for patients with large or calcified PDA, or plus complex congenital heart disease,using CPB and closing PDA from withing the pulmonary artery might be a more safe alternative technique.