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动脉导管未闭的外科治疗 |
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程颖 沈家宜 孔颂阳 戴备军 朱理
［摘要］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例，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。
［关键词］动脉导管未闭；外科治疗；手术方式
［中图分类号］R543.5 ［文献标识码］A ［文章编号］1005-6483(2000)04-0220-02
Surgical treatment for patent ductus arteriosus(PDA)
CHENG Ying SHEN Jiayi KONG Songyang
（Department of Cardiothoracic Surgery,Shenzhen Central Hospital,Shenzhen 518036，China）
［Abstract］Objective To study the proper choice of the operative methods for PDA.Methods The surgical treatments for 117 patients with PDA were reviewed,of which，42 cases accompanied with pulmonary hypertension,34 with intracardiac malformation.Via the left posterolateral incision,69 cases were performed by ligation,14 by division and suture.Via the median sternal incision, 5 cases were performed by ligation and 29 cases were repaired under extracorporeal circulation.Results No case showed recurrence of PDA after surgical management.One died during the operation,another case died of heart failure one year later.Two cases were complicated with the injury of the recurrent laryngeal nerve.Conclusions We suggest that the determination of surgical treatment for PDA should depend on the age of patient,the type and size of PDA,the accompaniment of PDA with pulmonary hypertension or intracardiac malformation.
［Key words］Patent ductus arteriosus;Surgical treatment;Operative method
动脉导管未闭(patent ductus arteriosus,PDA)是常见的先无性心脏病，我们自1989年7月～1999年6月外科手术治疗117例，现报告如下。
临床资料
一、一般资料
全组男39例，女78例，年龄15个月至49岁，平均(15.63±12.16)岁。胸骨左缘2、3肋间有连续性杂音101例，双期杂音5例，收缩期杂音11例，P2亢进96例。心胸比例(C/T)0.45～0.78，心电图示左心室高电压或肥大68例，右心室高电压或肥大32例，左、右心室高电压或肥大17例。病理分型：管型83例，漏斗型30例，窗型3例，瘤型1例。超声心动图或心导管检查诊断113例，漏诊4例。合并肺动脉高压42例，占35.90%，17例右心导管检查肺动脉压为81/30～124/56 mmHg，其中1例全肺阻力达944.88 dyn.s.cm-5(11.81 Wood单位)，存在差异性紫绀[1] [2] 下一页
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