Benjacholmas Vichai, Namchaisiri Jule, Lertsarpcharoen Pornthep, Punnahitananda Santi, Thaithumyanon Pimolrat
Department of Surgery, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand.
J Med Assoc Thai. 2009 Jul;92(7):909-13.
Failure of the ductus arteriosus to close after medical treatment is usually associated with many severe cardio-respiratory morbidities. Therefore, surgical ligation of symptomatic PDA is indicated in preterm newborn infants who do not respond or have contraindication of medical treatment.
To report the short-term outcomes of PDA ligation in preterm infants at a tertiary care hospital in Thailand.
Medical records of 42 preterm infants who underwent surgical ligation of PDA at King Chulalongkorn Memorial Hospital were reviewed All of the infants had symptomatic PDA that failed to respond to medical treatment or had a contraindication to indomethacin or ibuprofen. Surgical ligation of PDA was performed under general anesthesia. Morbidity and mortality occurring during hospitalization were reported.
There were 42 preterm infants in the present study. All of them had large PDA with intractable congestive heart failure. Mean + SD of birth weight and gestational age were 1206 +/- 567 grams and 28.7 +/- 3.6 weeks respectively. Mean +/- SD of the infants' weight and age at the time of surgery were 1089 +/- 549 grams and 17.5 +/- 12 days respectively. Data on the size of PDA was available on 21 preterm infants. Their ductus diameter (Mean +/- SD) was 3.1 +/- 1.1 mm. All infants were successfully extubated after PDA ligation. Twelve events of complications occurred in 11 infants (26.7%). All of the complications were of mild degree and resolved within a few days except one infant with left phrenic nerve injury that needed surgical plication of the diaphragm. Two infants died at 37 and 160 days after surgery and the latter infant developed IVH grade IV on the 15th day postoperatively. These complications were probably not related to PDA ligation.
PDA ligation was performed successfully on 42 preterm infants who had medical failure or had contraindication to medical treatment. Cardio-respiratory illnesses improved significantly after ligation. Two infant mortalities were not related to the procedure. Overall complication of surgery was 26.7% and resolved without sequelae.
药物治疗后动脉导管未闭通常与许多严重的心肺疾病相关。因此，对于无反应或有药物治疗禁忌证的早产新生儿，有症状的动脉导管未闭需行手术结扎。
报告泰国一家三级护理医院早产婴儿动脉导管未闭结扎术的短期结果。
回顾了朱拉隆功国王纪念医院42例接受动脉导管未闭手术结扎的早产婴儿的病历。所有婴儿均有症状性动脉导管未闭，对药物治疗无反应或有吲哚美辛或布洛芬的禁忌证。动脉导管未闭手术结扎在全身麻醉下进行。报告住院期间发生的发病率和死亡率。
本研究中有42例早产婴儿。他们均有大型动脉导管未闭伴难治性充血性心力衰竭。出生体重和胎龄的均值±标准差分别为1206±567克和28.7±3.6周。手术时婴儿体重和年龄的均值±标准差分别为1089±549克和17.5±12天。21例早产婴儿有动脉导管未闭大小的数据。其导管直径（均值±标准差）为3.1±1.1毫米。所有婴儿在动脉导管未闭结扎术后均成功拔管。11例婴儿（26.7%）发生了12次并发症事件。除1例左膈神经损伤婴儿需要手术缝合膈肌外，所有并发症均为轻度，且在数天内缓解。2例婴儿分别在术后37天和160天死亡，后一例婴儿在术后第15天发生IV级脑室内出血。这些并发症可能与动脉导管未闭结扎术无关。
对42例药物治疗失败或有药物治疗禁忌证的早产婴儿成功实施了动脉导管未闭结扎术。结扎术后心肺疾病明显改善。2例婴儿死亡与手术无关。手术总体并发症发生率为26.7%，且无后遗症地得到缓解。
