Perez C A, Bustorff-Silva J M, Villasenor E, Fonkalsrud E W, Atkinson J B
Division of Pediatric Surgery, University of California at Los Angeles School of Medicine, 90095-1749, USA.
Am Surg. 1998 Oct;64(10):1007-9.
We evaluated the outcome of a combined medical and surgical treatment of patent ductus arteriosus (PDA) in newborns weighing less than 1500 g. Charts were retrospectively reviewed for 76 newborns with a PDA between 1993 and 1997. Thirteen infants had pre-existing conditions prohibiting the use of indomethacin; eight were managed surgically, five medically. The remaining 63 infants received indomethacin therapy. Thirty-two medical failures occurred, requiring surgical ligation of the PDA. Those requiring surgery had a lower average birth weight (847 versus 997 g) and gestational age (26 versus 28 weeks; P < 0.05). Indomethacin treatment was successful in 27 infants. There were only three operative complications: a small pneumothorax, wound bleeding, and a small aortic tear. All recovered uneventfully and no deaths were attributable to the surgical procedure itself. There was no difference in the incidence of respiratory distress syndrome, duration of intubation, sepsis, neonatal enterocolitis, renal dysfunction, bleeding disorders, or intraventricular hemorrhage among both groups. Surgical ligation of a PDA is associated with a high success rate, a low incidence of complications, and no additional morbidity than indomethacin alone. We propose that surgical ligation should be regarded as a first line therapy for very small premature infants who are at higher risk of medical failure.
我们评估了体重不足1500克的新生儿动脉导管未闭（PDA）的内科与外科联合治疗结果。回顾性查阅了1993年至1997年间76例患有PDA的新生儿病历。13例婴儿因存在其他疾病而禁用吲哚美辛；其中8例行手术治疗，5例行内科治疗。其余63例婴儿接受了吲哚美辛治疗。32例内科治疗失败，需行PDA手术结扎。需要手术治疗的婴儿平均出生体重较低（847克对997克），胎龄也较小（26周对28周；P<0.05）。吲哚美辛治疗使27例婴儿获得成功。仅出现3例手术并发症：小气胸、伤口出血和小主动脉撕裂。所有患儿均顺利康复，无死亡病例归因于手术本身。两组在呼吸窘迫综合征发生率、插管持续时间、败血症、新生儿小肠结肠炎、肾功能障碍、出血性疾病或脑室内出血方面无差异。PDA手术结扎成功率高、并发症发生率低，且与单独使用吲哚美辛相比无额外发病率增加。我们建议，对于内科治疗失败风险较高的极小早产儿，手术结扎应被视为一线治疗方法。
