Han M T, Hall D G, Manché A, Rittenhouse E A
Department of Cardiovascular Surgery, Children's Hospital and Medical Center, Seattle, Washington 98105.
Am J Surg. 1993 May;165(5):628-31. doi: 10.1016/s0002-9610(05)80449-0.
Since 1972, 17 patients have been surgically treated for double aortic arch at our institution. The procedure became necessary before 12 months of age in 11 patients and before 24 months in 16 patients. The major symptoms were respiratory distress, noisy breathing, and respiratory infections; four patients also had dysphagia. A high degree of clinical suspicion should warrant further investigation. Barium swallow and bronchoscopy were diagnostic and revealed extrinsic compression of the esophagus and trachea, respectively. Division of the anterior arch was performed in 16 patients; the right (posterior) arch was divided in the remaining patient. Kommerell's diverticulum was found in four patients and was resected in order to avoid recurrence of dysphagia by compression. A vascular suspension procedure was necessary in 13 patients to further release the trachea and esophagus. There was no mortality in this series, and symptomatic improvement was achieved in all patients. A degree of tracheomalacia may be responsible for some residual symptoms in four patients.
自1972年以来，我院共有17例双主动脉弓患者接受了手术治疗。11例患者在12个月龄前、16例患者在24个月龄前就有必要进行该手术。主要症状为呼吸窘迫、呼吸嘈杂和呼吸道感染；4例患者还伴有吞咽困难。高度的临床怀疑应促使进一步检查。吞钡检查和支气管镜检查具有诊断价值，分别显示食管和气管受到外部压迫。16例患者进行了前弓离断术；其余1例患者离断的是右（后）弓。4例患者发现有Kommerell憩室，为避免吞咽困难因压迫复发而将其切除。13例患者需要进行血管悬吊术以进一步松解气管和食管。该系列病例无死亡病例，所有患者症状均有改善。4例患者的一些残留症状可能与一定程度的气管软化有关。
