Iwase Jinichi, Tajima Kazuyoshi, Io Akinori, Katoh Wataru, Tanaka Keisuke, Toki Sachie, Iwasa Mitsuji, Sobajima Hisanori, Yamada Yasumasa, Takasu Hiroe
Department of Cardiovascular Surgery, Nagoya Daini Red Cross Hospital, Nagoya, Japan.
Jpn J Thorac Cardiovasc Surg. 2003 Dec;51(12):651-5. doi: 10.1007/s11748-003-0003-x.
Minimally invasive surgery is widely used in pediatric surgery. Extremely low birth weight infants (ELBWI) are literally so fragile to surgical stress that the minimum invasive procedures should be required. We report 15 ELBWI cases with patent ductus arteriosus (PDA), who underwent surgical closure. All of them had failed treatment with indomethacin to close PDA or had contraindicated to its use. The mean gestational age at birth was 26.0+/-2.7 weeks (24-34 weeks) and birth weight 702+/-140 g (479-966 g). The mean age at operation was 23+/-11 days (2-48 days) and body weight at operation 679+/-151 g (428-969 g). The surgery-related mortality was none. No complications were also encountered. Our surgical procedures consist of 2 modalities, one is clipping PDA, not ligation. Clipping technique attributes to minimize the dissection of surrounding tissue of PDA. The other is posterolateral muscle sparing thoracotomy, which would reduce long-term physical impairment and deformity. We believe our surgical technique can be accomplished safely and would be an alternative approach for ELBWI with a lower probability of PDA closure with indomethacin or an increased risk of complications for medical treatment.
微创手术在小儿外科中广泛应用。极低出生体重儿（ELBWI）对手术应激极其脆弱，因此应采用最小侵入性手术。我们报告了15例患有动脉导管未闭（PDA）的极低出生体重儿接受了手术闭合治疗。他们均因使用吲哚美辛关闭动脉导管未闭失败或存在使用禁忌。出生时的平均胎龄为26.0±2.7周（24 - 34周），出生体重为702±140克（479 - 966克）。手术时的平均年龄为23±11天（2 - 48天），手术时体重为679±151克（428 - 969克）。手术相关死亡率为零。也未遇到并发症。我们的手术方法包括两种方式，一种是夹闭动脉导管未闭，而非结扎。夹闭技术有助于减少动脉导管周围组织的分离。另一种是后外侧保留肌肉的开胸术，这将减少长期身体损伤和畸形。我们相信我们的手术技术可以安全完成，并且对于那些使用吲哚美辛关闭动脉导管未闭可能性较低或药物治疗并发症风险增加的极低出生体重儿来说，将是一种替代方法。
