Miles R H, DeLeon S Y, Muraskas J, Myers T, Quinones J A, Vitullo D A, Bell T J, Fisher E A, Pifarre R
Department of Thoracic-Cardiovascular Surgery, Loyola University Medical Center, Maywood, Illinois 60153.
Ann Thorac Surg. 1995 Mar;59(3):668-70. doi: 10.1016/0003-4975(94)00996-1.
During a 30-month period, 34 premature infants underwent surgical closure of a patent ductus arteriosus. The mean gestational age at birth was 25 +/- 0.3 weeks and the mean age at the time of operation was 3 +/- 0.3 weeks (mean weight, 829 +/- 54 g). Indomethacin therapy had failed in 32 patients, and 2 had contraindications to its use. The initial 8 patients had parascapular incision and ligation of the patent ductus arteriosus; the last 26 patients had a short transaxillary incision and clipping. The average duration of the operation from the time of incision to skin closure was 36 +/- 2 minutes (range, 15 to 65 minutes). One patient (3%) needed chest tube insertion intraoperatively because of visceral pleura disruption. Two patients (5.8%) had a "small pneumothorax" (< 10% of the lung field) that resolved within 24 hours. There was no morbidity or mortality directly related to the operative procedure, although 3 patients (8.8%) ultimately died from problems related to their severe prematurity. We conclude that surgical closure of patent ductus arteriosus without chest tube drainage can be accomplished safely in premature infants. Postoperative nursing care is simplified and the cost is reduced because the need for the chest tube and drainage system is eliminated and the number of chest radiograms needed postoperatively is reduced.
在30个月的时间里，34例早产儿接受了动脉导管未闭的手术闭合治疗。出生时的平均胎龄为25±0.3周，手术时的平均年龄为3±0.3周（平均体重829±54克）。32例患者吲哚美辛治疗失败，2例有使用吲哚美辛的禁忌证。最初的8例患者采用肩胛旁切口并结扎动脉导管未闭；最后的26例患者采用短的经腋窝切口并夹闭。从切开到皮肤缝合的平均手术时间为36±2分钟（范围15至65分钟）。1例患者（3%）因脏层胸膜破裂术中需要插入胸管。2例患者（5.8%）出现“小气胸”（<肺野的10%），在24小时内自行缓解。尽管有3例患者（8.8%）最终死于与严重早产相关的问题，但没有与手术操作直接相关的发病率或死亡率。我们得出结论，在早产儿中可以安全地完成无需胸管引流的动脉导管未闭手术闭合。由于无需胸管和引流系统，且术后所需胸部X线片数量减少，术后护理得到简化，成本降低。
