Department of Thoracic and Cardiovascular Surgery, Inha University Hospital, Incheon, Korea.
J Korean Med Sci. 2010 Jan;25(1):24-7. doi: 10.3346/jkms.2010.25.1.24. Epub 2009 Dec 26.
The surgical closure of patent ductus arteriosus (PDA) is provided more frequently in extremely low birth weight babies who are usually deemed unsuitable for pharmacological closure. We have adopted subaxillary mini-thoracotomy in order to lessen surgical trauma in these babies; and its clinical results were analyzed. From April 2004 to August 2008, out of 50 babies at the neonatal intensive care unit who underwent the surgical closure of PDA, 22 premature babies weighing less than 1 kg at operation were included in the study. Eleven babies were males and mean gestational age was 27 weeks ranging from 23(+3) to 30(+2) weeks. Mean body weight at operation was 816 g ranging from 490 to 989 g and average age at operation was 17.9+/-11.9 days. Of them, 17 babies (72%) were ventilator dependent preoperatively, as compared with 13 out of 28 (46%) babies that weighed more than 1 kg (P<0.05). Four babies did not survive to discharge. Among 28 babies who were heavier than 1 kg, there were only one death. However, the mortality difference was not statistically significant (P=0.11). All mortalities were caused by inherent problems of prematurity and co-morbidities. Out of 17 babies who had been ventilator dependent preoperatively, 13 weaned off successfully at 17.0+/-23.9 days after the operation. The baby patients heavier than 1 kg weaned at 6.0+/-5.3 days (P=0.27). Surgical outcome of simple and less invasive subaxillary mini-thoracotomy was satisfactory; the surgery is highly recommended for ductal closure in extremely low weight premature babies.
动脉导管未闭（PDA）的手术闭合在极低出生体重儿中更为常见，这些婴儿通常被认为不适合药物闭合。我们采用了腋下小切口开胸术，以减轻这些婴儿的手术创伤；并分析了其临床结果。2004 年 4 月至 2008 年 8 月，新生儿重症监护病房 50 例接受动脉导管未闭手术闭合的婴儿中，有 22 例手术时体重小于 1kg 的早产儿纳入研究。11 例为男性，平均胎龄为 27 周，范围为 23（+3）至 30（+2）周。平均手术体重为 816g，范围为 490 至 989g，平均手术年龄为 17.9+/-11.9 天。其中 17 例（72%）术前依赖呼吸机，而体重超过 1kg 的 28 例婴儿中只有 13 例（46%）（P<0.05）。有 4 例婴儿未存活至出院。在 28 例体重超过 1kg 的婴儿中，只有 1 例死亡。然而，死亡率差异无统计学意义（P=0.11）。所有死亡均由早产儿的固有问题和合并症引起。在术前依赖呼吸机的 17 例婴儿中，有 13 例在术后 17.0+/-23.9 天成功脱机。体重超过 1kg 的婴儿脱机时间为 6.0+/-5.3 天（P=0.27）。简单且微创的腋下小切口开胸术的手术结果令人满意；对于极低体重早产儿的动脉导管闭合，该手术强烈推荐。
