先天性心臟病動脈導管開放症

Surgical Management of Patent Ductus Arteriosus

俞紹基(S. C. Yu) ； 林信男(S. N. Lin) ； 鄭敏盛(M. S. Cheng)

《Journal of Medical Sciences》 2卷1期 (1977/01) Pp. 453-459

摘要

動脈導管開放症為比較常見的先天性心臟病，女性較男性為多，約為三比一。多數病人可藉典型之連續性心雜音、心電圖及胸部X光檢查而確定診斷。但於非典型的病例，必須作較特別的檢查，像心導管、心臟血管攝影術或逆行主動脈攝影術等，以與主動脈竇動脈瘤破裂入心腔，主動脈肺動脈窗及冠狀動靜脈瘻等，作鑑別診斷。此症若不治療，可發生肺動脈高壓症及細菌性心內膜炎等合併症。手術治療之危險性甚小，而結果良好。雖然有學者報告以非開胸手術方法治療，但並未為大多數外科醫師所接受。本院從1960年元月到1975年12月之十五年中，經手術前診斷為動脈導管開放症者共56例。其中有一例於手術時診斷為主動脈肺動脈窗。此55例中，女性佔42例，男性佔13例。除一例因為住院時有嚴重肺動脈高壓症不宜手術外，其餘54例均接受外科手術治療。患者年齡最小十五個月，最大四十三歲。手術採用三次縫線結紮術或切斷縫合術。除少數發生合併症外，沒有手術死亡，結果令人滿意。

並列摘要

Congenital heart disease with patent ductus arterious is a curable disease. When the disease is handled adequately and in time, the risk of operation is minimal and the prognosis is excellent.From January 1960 to December 1975, fifty six cases had been treated in our service of cardiovascular surgery. One of those cases turned out to be a case of aorticopulmonary window. All patients, except one who was considered not fit for surgery because of severe pulmonary hypertension, were treated surgically without mortality, including one 43-years old female patient who had aneurysmal formation presumably due to delay of treatment.There were eight postoperative complications including one atelectasis, one wound infection, two temporary hoarseness of voice and four mild pneumothorax and subcutaneous emphysema after chest extubation. The importance of early surgical treatment for preventing late complications such as pulmonary hypertension and aneurysmal formation etc. has been emphasized.