Forbes T L, Evans M G
Division of Paediatric Surgery, University of Western Ontario, Canada.
J Pediatr Surg. 1996 Jun;31(6):765-7. doi: 10.1016/s0022-3468(96)90127-x.
Open surgical ligation has proven to be a safe and effective method to bring about closure of the patent ductus arteriosus (PDA). Recent studies have suggested that percutaneous transcatheter and video-assisted thorascopic closure may be better and more cost-effective techniques for PDA closure. The authors reviewed their experience with open thoracotomy for the elective ligation of PDA in 42 children over a 3-year period. The male:female ratio was 1.6:1; the age of the patients (mean +/- SD) was 2.8 +/- 2.3 years and their weight was 14 +/- 7 kg. In all cases the diagnosis was confirmed preoperatively by echocardiography. Open ligation of the PDA was performed through a limited left posterolateral thoracotomy with exposure, by an extrapleural approach. Closure was established with two silk ligatures or a silk ligature and clip, and drainage of the extrapleural space was not used. The operating time was 85 +/- 12 minutes. The total duration of hospitalization was 3.1 +/- 0.8 days. There were no deaths. Successful closure was confirmed by auscultation in 39 children and by subsequent echocardiography in three patients. No surgical complications occurred, and no transfusions were required. Minor respiratory symptoms occurred in two patients postoperatively. Transient systemic hypertension was seen in two patients, and one wound infection occurred.
开放性手术结扎已被证明是实现动脉导管未闭（PDA）闭合的一种安全有效的方法。最近的研究表明，经皮导管介入和电视辅助胸腔镜闭合术可能是更优且更具成本效益的PDA闭合技术。作者回顾了他们在3年期间对42例儿童进行择期PDA结扎开放性开胸手术的经验。男女比例为1.6:1；患者年龄（均值±标准差）为2.8±2.3岁，体重为14±7千克。所有病例术前均经超声心动图确诊。PDA的开放性结扎通过有限的左后外侧开胸术经胸膜外途径暴露后进行。用两根丝线结扎或一根丝线结扎加夹子完成闭合，未使用胸膜外间隙引流。手术时间为85±12分钟。总住院时间为3.1±0.8天。无死亡病例。39例儿童经听诊证实闭合成功，3例患者经后续超声心动图证实。未发生手术并发症，无需输血。两名患者术后出现轻微呼吸道症状。两名患者出现短暂性系统性高血压，发生1例伤口感染。
