Barral Xavier, de Latour Bertrand, Vola Marco, Lavocat Marie Pierre, Fichtner Christine, Favre Jean Pierre
Department of Cardiovascular Surgery, Hôpital Nord-CHU, Avenue Albert Raimond, 42055 Saint-Etienne, France.
J Vasc Surg. 2006 Jun;43(6):1138-44. doi: 10.1016/j.jvs.2006.01.033.
The aim of this study was to evaluate the late results in adult patients who underwent surgery of the abdominal aorta as children.
During a 17-year period, eight children underwent surgery for lesions of the abdominal aorta. There were 6 boys and 2 girls, with an average age of 10 years. The presenting symptom that led to diagnosis of abdominal aortic lesions was hypertension in five cases and lower-limb claudication in three. The underlying disease was middle aortic syndrome in three cases, infrarenal aortic hypoplasia in two, infrarenal aortic aneurysm in two, and Takayasu's disease in one. Five children had associated renal artery lesions, including four with bilateral lesions and one with a unilateral lesion. Aortic bypass was used in all cases. A straight tube graft was placed between the distal descending thoracic or supraceliac aorta and the infrarenal aorta in six cases, and a bifurcated bypass was placed between the infrarenal aorta and the iliac arteries in two. Renal artery revascularization procedures (n = 9) included ex vivo repair with renal autotransplantation in five cases, direct reimplantation on the arch of Riolan in two, and direct reimplantation of the renal artery onto the aortic graft in two.
One patient died on postoperative day 1. The remaining seven patients recovered uneventfully. Mean follow-up was 10.2 years. No patient was lost to follow-up. Further surgical intervention was required in three patients. The indications for additional surgery were fibrosis of a renal artery reimplanted onto the graft at 3 years, deterioration of the aortoaortic graft at 5 years, and false iliac aneurysm at 20 years. All seven patients had normal physical development. The average increase in height and weight were 28.5 cm and 26.2 kg, respectively. All patients had normal sexual function, and two are parents. All patients are currently asymptomatic. Short Form 36 scores for quality-of-life parameters were 78% to 83%.
Late results of abdominal aortic surgery in children, in our experience, are encouraging. Quality of life in adulthood was excellent. Insofar as possible, correction should be deferred until the child is 8 to 10 years old so that a prosthesis of sufficient diameter can be used.
本研究的目的是评估儿童时期接受腹主动脉手术的成年患者的远期结果。
在17年期间，8名儿童接受了腹主动脉病变手术。其中男孩6名，女孩2名，平均年龄10岁。导致腹主动脉病变诊断的主要症状为5例高血压和3例下肢间歇性跛行。潜在疾病包括3例中主动脉综合征、2例肾下腹主动脉发育不全、2例肾下腹主动脉瘤和1例大动脉炎。5名儿童伴有肾动脉病变，其中4例为双侧病变，1例为单侧病变。所有病例均采用主动脉旁路手术。6例在降主动脉远端或腹腔动脉上主动脉与肾下腹主动脉之间放置直管移植物，2例在肾下腹主动脉与髂动脉之间放置分叉旁路移植物。肾动脉血运重建手术（n = 9）包括5例自体肾移植体外修复、2例在Riolan弓上直接再植、2例肾动脉直接再植到主动脉移植物上。
1例患者术后第1天死亡。其余7例患者恢复顺利。平均随访10.2年。无患者失访。3例患者需要进一步手术干预。再次手术的指征分别为3年时移植到移植物上的肾动脉纤维化、5年时主动脉-主动脉移植物恶化以及20年时髂总动脉瘤。所有7例患者身体发育正常。身高和体重平均增加分别为28.5 cm和26.2 kg。所有患者性功能正常，2例已为人父母。所有患者目前均无症状。生活质量参数的简短健康调查问卷36项评分在78%至83%之间。
根据我们的经验，儿童腹主动脉手术的远期结果令人鼓舞。成年后的生活质量良好。只要有可能，手术矫正应推迟到儿童8至10岁，以便能够使用足够直径的假体。
