Backer Carl L
Division of Cardiovascular-Thoracic Surgery, Ann & Robert H. Lurie Children's Hospital of Chicago, A.C. Buehler Professor of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois.
Semin Thorac Cardiovasc Surg Pediatr Card Surg Annu. 2020;23:48-52. doi: 10.1053/j.pcsu.2020.02.004.
Our series of vascular ring patients treated at Ann & Robert H. Lurie Children's Hospital of Chicago has now exceeded 450 patients (see Central Picture). The recommendations from this review are based on our experience with those patients. Since 1990, we have used preoperative cross-sectional imaging in all vascular ring patients. This has led us to refine our operative strategies and carefully tailor the operation to the individual's unique anatomy. In particular for right aortic arch patients, we now address the Kommerell diverticulum in most cases and carefully consider Kommerell diverticulum resection with left subclavian artery transfer. In double aortic arch patients, we also look for a Kommerell diverticulum and resect the diverticulum if present. This will decrease the number of patients presenting for a reoperation after initial vascular ring surgery. Since 1947, we have operated on 217 patients with a right aortic arch. The median age is 1.5 years. Since 2006, 47 out of 111 patients have had Kommerell diverticulum resection and left subclavian artery transfer to the left carotid artery. Mean length of stay is 4.5 days. In the same time period, 187 patients have been treated for a double aortic arch. The median age is 1 year. Twelve of these patients also had resection of a Kommerell diverticulum. The mean length of stay in this group was 3 days. Advanced preoperative cross-sectional imaging leads to precise operative techniques tailored to the unique anatomy of each vascular ring patient.
我们在芝加哥安&罗伯特·H·卢里儿童医院治疗的一系列血管环患者现已超过450例（见中心图片）。本综述中的建议基于我们对这些患者的治疗经验。自1990年以来，我们对所有血管环患者均采用术前横断面成像。这使我们能够优化手术策略，并根据个体独特的解剖结构精心调整手术方案。特别是对于右位主动脉弓患者，我们现在在大多数情况下处理Kommerell憩室，并仔细考虑Kommerell憩室切除术及左锁骨下动脉移位术。对于双主动脉弓患者，我们也会寻找Kommerell憩室，若存在则将其切除。这将减少初次血管环手术后需要再次手术的患者数量。自1947年以来，我们已为217例右位主动脉弓患者实施手术。中位年龄为1.5岁。自2006年以来，111例患者中有47例接受了Kommerell憩室切除术及左锁骨下动脉向左侧颈动脉的移位术。平均住院时间为4.5天。在同一时期，187例患者接受了双主动脉弓治疗。中位年龄为1岁。其中12例患者也接受了Kommerell憩室切除术。该组患者的平均住院时间为3天。先进的术前横断面成像可带来针对每位血管环患者独特解剖结构的精确手术技术。
