自体心包组织重建右室流出道肺动脉连接治疗肺动脉闭锁并室间隔缺损的疗效分析

doi:10.3969/j.issn.1005-6483.2021.06.003

摘要/Abstract

摘要： 目的:探讨自体心包组织重建右心室流出道肺动脉连接治疗肺动脉闭锁并室间隔缺损(pulmonary atresia with ventricular septal defect，PA/VSD)的临床效果。方法:2010年1月~2019年6月我院收治的PA/VSD病人41例；均采用自体心包组织重建右心室流出道及肺动脉，行一期姑息治疗13例，行一期根治28例。分析术后早期结果，随访观察右室流出道及左、右肺动脉发育情况、肺动脉与三尖瓣返流情况、右室功能等指标，评价治疗效果。结果:术后早期死亡3例。存活38例，病人体外循环时间(121.2±84.7)分钟，呼吸机辅助时间(184.5±79.3)小时，ICU停留时间(16.6±7.4)天，均恢复顺利出院。随访6个月~11年，随访期间死亡1例，右室流出道或肺动脉分支相对狭窄3例。9例行二期根治术。与术后早期比较，右室流出道直径增加不明显，差异无统计学意义(P>0.05)，左、右肺动脉直径增长明显，差异有统计学意义(P<0.05)，肺动脉返流面积增加[(2.46±0.46)cm2 vs(1.18±0.25)cm2 ,P<0.05]，三尖瓣返流面积大于术后早期[(1.48±0.26)cm2 vs(0.95±0.21)cm2 ,P<0.05],右心室功能整体良好。结论:自体心包重建右室流出道肺动脉治疗PA/VSD，手术效果满意。随访中重建的右室流出道及肺动脉分支有生长趋势，但肺动脉、三尖瓣返流程度有加重趋势，需随访观察。

关键词: 肺动脉闭锁/室间隔缺损, 自体心包, 右心室流出道重建术, 并发症

Abstract: Objective:To explore the clinical effect of autologous pericardial tissue reconstruction of right ventricular outflow tractpulmonary artery connection in the treatment of PA/VSD and to summarize experience.Methods:41 cases of PA/VSD from January 2010 to June 2019 were analyzed retrospectively.Thirteen cases received first-stage palliative care and 28 cases received firststage radical treatment. Early postoperative results were analyzed, and the development of right ventricular outflow tract, left and right pulmonary artery, pulmonary artery and tricuspid regurgitation, right ventricular function and other indicators were followed up to evaluate the treatment effect.Results：3 patients died after operation,28 patients underwent primary radical operation,13 patients underwent palliative right ventricular outflow tract reconstruction.The CPB time was(121.2±84.7)min of 38 patients,ventilator assistance time was (184.5±79.3) hours,aortic occlusion time was(85.2±36.4)min,ventilat,ICU stay time was(16.6±7.4)d.Follow up 6 months11 years,1 case died,3 cases had relatively narrow of right ventricular outflow tract or pulmonary artery branch,9 cases had twostage radical operation.Compared with the early postoperative period,the diameter of left and right pulmonary arteries branches increased significantly(P<0.05),and the areas of pulmonary artery regurgitation[(2.46±0.46)cm2 vs(1.18±0.25)cm2 ,P<0.05] and tricuspid valve regurgitation[(1.48±0.26)cm2 vs(0.95±0.21)cm2 ,P<0.05] were larger.Conclusion：Autogenous pericardial reconstruction of right ventricular outflow tract pulmonary artery for PA/VSD shows satisfactory results.During the followup,the right ventricular outflow tract and pulmonary artery branches showed a growing trend,and the degree of pulmonary valve and tricuspid valve regurgitation tended to aggravate.

Key words: pulmonary atresia/ventricular septal defect, autologous pericardium, right ventricular outflow tractpulmonary artery reconstruction, complications

陈义初, 余帅, 祁海杰等. 自体心包组织重建右室流出道肺动脉连接治疗肺动脉闭锁并室间隔缺损的疗效分析[J]. 临床外科杂志, 2021, 29(6): 508-511.

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