动脉导管未闭手术方法的选择

The optional surgical approach for patients with patent ductus arterious

  • 摘要: 目的:分析130例动脉导管未闭患者手术治疗,探讨其手术适应证。方法:左后外侧开胸,单纯结扎77例,加垫结扎8例,单纯胸膜外结扎12例。体外循环下经肺动脉切口缝合动脉导管33例。结果:本组无死亡。动脉导管结扎后再通3例,1例再手术,另2例超声心动图提示肺动脉水平有微量的左向右分流,无需再手术。喉返神经损伤1例。结论:我们认为有心脏复合畸形、严重肺动脉高压需在体外循环下手术;胸膜外处理导管最适用于小儿;动脉导管直径小于1.0cm,可单纯结扎;直径1.0~2.0cm,可在导管前壁上加垫结扎

     

    Abstract: Objective:In order to investigate the indications of various surgical methods 130 cases with different types of patent ductus arterious (PDA) were analysed.Methods:Seventy-seven cases operatied on by simple ligation, 8 by simultaneous addition of cushion and ligation and 12 received extrapleural ligation with left posteriolaterl thoracotomy. The other 33 were sutured via the incision of pulmonary artery under cardiopulmonary bypass (CPB). Results:No any operative death in this group. Recurrence of PDA occured in three patients with simple ligation. One of them received second operation and the other two had residuce trivial left-to-right shunt at the level of pulmonary unnecessary reoperation state evaluated by UCG. The recurrent laryngeal nerve was injured in one patient.Conclusion:We recommend that patients with heavy pulmonary hypertension should be operated under CPB; the children with simple PDA may be ligated more properly via extrapleura approach; if the diameter of PDA is 1.0~2.0 cm it may be simultaneously added the cushion on the front wall of PDA and ligated.

     

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