右侧主动脉弓对食管闭锁和气管食管瘘患儿预后的影响。
The effect of a right-sided aortic arch on outcome in children with esophageal atresia and tracheoesophageal fistula.
作者信息
Allen Steven R, Ignacio Romeo, Falcone Richard A, Alonso Maria H, Brown Rebeccah L, Garcia Victor F, Inge Thomas H, Ryckman Frederick C, Warner Brad W, Azizkhan Richard G, Tiao Gregory M
机构信息
Division of Pediatric and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, OH 45229, USA.
出版信息
J Pediatr Surg. 2006 Mar;41(3):479-83. doi: 10.1016/j.jpedsurg.2005.10.051.
UNLABELLED
During repair of an esophageal atresia with tracheoesophageal fistula (EA/TEF), a right-sided aortic arch (RAA) presents a technical challenge. We reviewed our experience with EA/TEF focusing on the impact of RAA.
METHODS
A retrospective review of patients with EA/TEF at our institution from 1990 to 2004 was performed. Of 61 patients, 53 had a left aortic arch (LAA) and 8 had RAA.
RESULTS
The mean gestational age and birth weight were similar between patients with LAA and RAA. There were more vascular rings in patients with RAA than with LAA (37.5% vs 3.8%, P = .009). A preoperative echocardiogram correctly identified the location of the arch in all with LAA but only 62.5% of those with RAA. Operative complications occurred in 25% of patients with RAA and 11% of patients with LAA.
CONCLUSIONS
Management of a child with RAA and EA/TEF is technically challenging. Preoperative identification of the great vessel anomalies may impact operative decision making. Therefore, careful diagnostic evaluation of a patient with an aortic arch that cannot be easily defined by ECHO should be considered before definitive repair.
未标注
在修复食管闭锁合并气管食管瘘（EA/TEF）时，右侧主动脉弓（RAA）带来了技术挑战。我们回顾了我们在EA/TEF方面的经验，重点关注RAA的影响。
方法
对1990年至2004年在我们机构接受治疗的EA/TEF患者进行回顾性研究。61例患者中，53例有左主动脉弓（LAA），8例有RAA。
结果
LAA和RAA患者的平均孕周和出生体重相似。RAA患者的血管环比LAA患者更多（37.5%对3.8%，P = 0.009）。术前超声心动图能正确识别所有LAA患者的主动脉弓位置，但只能识别62.5%的RAA患者。RAA患者的手术并发症发生率为25%，LAA患者为11%。
结论
RAA合并EA/TEF患儿的治疗在技术上具有挑战性。术前识别大血管异常可能会影响手术决策。因此，在进行确定性修复之前，对于超声心动图难以明确主动脉弓情况的患者，应考虑进行仔细的诊断评估。
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