动脉导管未闭外科治疗进展研究

Advances in Surgical Treatment of Patent Ductus

摘要: 动脉导管未闭是常见先天性心脏病之一，其治疗策略正由传统开胸结扎向微创外科、经导管封堵及完全超声引导封堵并行发展的多路径模式演进。本文围绕动脉导管未闭外科治疗的主要进展展开综述，系统梳理经左胸后外侧切口结扎术、经腋下小切口结扎术、胸腔镜辅助结扎术、机器人辅助结扎术及经皮封堵术的技术特点、适用范围、临床效果与局限，并重点分析完全超声引导下封堵术的循证依据及应用前景。研究表明，传统开胸和小切口术式在低体重儿、复杂解剖及介入失败补救中仍具重要价值；胸腔镜和机器人技术可在合适病例中减少胸壁创伤、促进术后恢复，但其获益受体重分层、导管形态及团队经验影响明显；经导管封堵尤其是完全超声引导下封堵术显示出良好的近期成功率和微创优势，但在低体重及复杂病例中的适用性仍需进一步明确。本研究认为，当前尚不存在适用于所有患者的单一最优术式，动脉导管未闭治疗应在解剖特征、体重分层、全身状况及医疗资源等因素基础上进行个体化决策。本文研究结论可为临床根据患者个体情况选择最优治疗策略提供可靠参考。

Abstract: Patent Ductus Arteriosus (PDA) is one of the most common congenital heart diseases. Its therapeutic strategy is evolving from conventional open ligation toward a multimodal paradigm integrating minimally invasive surgery, transcatheter closure, and completely echocardiography-guided closure. This article reviews the major advances in the surgical management of PDA, with a systematic analysis of the technical characteristics, indications, clinical outcomes, and limitations of left posterolateral thoracotomy ligation, subaxillary mini-incision ligation, video-assisted thoracoscopic ligation, robot-assisted ligation, and percutaneous closure. Particular emphasis is placed on the evidence base and clinical prospects of completely echocardiography-guided closure. Current evidence indicates that conventional thoracotomy and mini-incision approaches remain of substantial value in low-body-weight infants, patients with complex ductal anatomy, and salvage treatment after failed catheter-based intervention. Thoracoscopic and robotic techniques can reduce chest wall trauma and facilitate postoperative recovery in appropriately selected patients, although their benefits are significantly influenced by body-weight stratification, ductal morphology, and institutional experience. Transcatheter closure, especially completely echocardiography-guided closure, has demonstrated favorable short-term success rates and minimally invasive advantages; however, its applicability in low-body-weight infants and anatomically complex cases requires further clarification. This study suggests that no single procedure is currently optimal for all patients, and treatment selection for PDA should be individualized on the basis of anatomical characteristics, body-weight stratification, overall clinical status, and available medical resources. The conclusions of this review may provide a reliable reference for clinicians in selecting the optimal therapeutic strategy according to individual patient characteristics.