14例儿童冠状动脉瘘合并其他心内畸形的外科治疗

Surgery of coronary artery fistula combined with other intracardiac malformations in 14 children

摘要:

目的：总结儿童冠状动脉瘘合并其他心内畸形外科治疗的临床经验及效果。方法：回顾性分析2010年3月至2018年6月于重庆医科大学附属儿童医院心胸外科行手术治疗的冠状动脉瘘合并其他心内畸形患儿14例，其中男9例，女5例，年龄0.25～13.25岁[平均（2.95±3.47）岁]，体质量2.8～37 kg[平均（10.98±8.87） kg]。结果：所有患儿均成功手术，手术时间105～305 min[平均（183.36±48.64） min]，体外循环时间40～172 min[平均（91.29±31.49） min]，主动脉阻断时间16～107 min[平均（45.93±25.64） min]，术后住院时间7～19 d[平均（10.79±3.14） d]，重症监护时间1～9 d[平均（3.21±2.04） d]，术后呼吸机辅助呼吸时间2 h 44 min至6 d[平均（18.73±37.38） h]，术中出血5～50 mL[平均（18.93±15.71） mL]；术后肺实变、胸腔积液各2例，气胸、心包积液各1例，完全性右束支阻滞1例，心包填塞后床旁开胸抢救1例，全组无死亡，出院后随访6个月至3年，无再次住院手术患儿，远期生存良好。结论：儿童冠状动脉瘘合并其他心内畸形一经确诊，需及早治疗，外科手术治疗效果好。

Abstract:

Objective：To summarize the clinical experience and the effectiveness of surgery on coronary artery fistula with other in－tracardiac malformations in children. Methods：A total of 14 children （nine males and five females），aged 0.25-13.25 years old [mean （2.95±3.47） years old]，weighed 2.8-37 kg [mean（10.98±8.87） kg] and underwent surgery of coronary artery fistula combining with other intracardiac malformations in our department from March 2010 to June 2018 were included and retrospectively analyzed in this study. Results：All included children were operated successfully，with operation time of 105-305 min [mean（183.36±48.64） min]，cardiopulmonary bypass time of 40-172 min [mean（91.29±31.49） min]，aortic occlusion time of 16-107 min [mean（45.93±25.64） min]，postoperative hospitalization of 7-19 d [mean（10.79±3.14） d]，intensive care time of 1-9 d [mean（3.21±2.04） d]，postoperative ventilator assisted breathing time of 2h 44 min-6 d[mean（18.73±37.38） h] and intraoperative bleeding of 5-50 mL [mean（18.93±15.71） mL]. After operation，there were two children had pulmonary consolidation，two children had pleural effusion，one child had pneumothorax，one child had pericardial effusion，one child had complete right bundle branch block and one child had pericardial tamponade and emergency beside thoracotomy. No death occurred in the group. After a follow-up of 6 months-3 years，all included children didn’t experience in-hospital operation again and had good long-term survival. Conclusion：Diagnosed coronary artery fistula with other intracardiac malformations in children should be treated early，and the effectiveness of surgery is good.