摘要
目的探讨和评价小儿肺动脉闭锁(PA)伴室间隔缺损(VSD)右室流出道重建方法的应用.方法 1999年4月至2004年12月,收治81例PA伴VSD行一期或分期的双心室修补术病儿.一期根治术组32例,大部分病例采用自体心包片跨瓣环水平扩大右室流出道至肺总动脉,其中4例带心包单瓣,合并主肺动脉侧支(MAPCAs)的11例中有2例完成肺动脉血管的单元化手术.姑息手术组49例,分别采用不同的右室流出道重建方法.其中15例完成了二期根治术,大部分采用同种异体心包片跨瓣补片.结果一期根治术死亡4例(12.5%);姑息手术死亡3例(6.1%);二期根治术无死亡.出院时根治术组经皮氧饱和度0.95～0.98.随访3～24个月.姑息手术为0.79～0.87,McGoon指数从0.4～0.7增至1.1～1.6.结论术前判断肺动脉干、肺动脉分支发育情况、中央共汇、有无MAPCAs,对手术方法的选择极为重要.术后PRV/PLV的测定有助于右室流出道重建方法预后的评估.
Objective To evaluate the surgical approach of right ventricular outflow tract construction （RVOT） for pulmonary atresia （PA） with ventricular septal defect （VSD） in infant and younger children. Methods From June 1999 to December 2004, 81 cases of PA with VSD were corrected by primary repair, palliative repair or staged repair. There were 2 groups according to different surgical approachs. Group one, 32 patients underwent biventricular primary repair and underwent transannular patching with autologous pericardial flake in lots of patients in which 4 cases with pericardial valved flake. 2 of 11 cases of PA with MAPCAs underwent pulmonary artery unifoclization operation. Group two, 49 patients underwent palliative repair. They underwent different surgical approach of fight ventricular outflow tract construction according to preoperation condition, 15 cases underwent staged radical repair in which transannular patching with homovariant pericardial flake. Results For primary radical repair, 4 patients died with a mortality of 12.5%. For palliative repair, 3 patients died with a mortality of 6.1%. There was no death for staged radical repair. The mean oxygen saturation was 0.95 - 0.98 for radical repair. The results of the follow-up were satisfctory from 3 months to 2 years. The mean oxygen saturation was 0.79 - 0.87 for palliative repair. The rate of McGonn was increased from 0.4 - 0.7 to 1.1 - 1.6. The key to success of surgical approach is precise evaluation of edvelopment of pulmonary artery, pulmonary artery conference, and before operation. The PRV/PLY was also the key for prognosis of the surgical approach of RVOT construction.
出处
《中华胸心血管外科杂志》
CSCD
北大核心
2005年第5期257-259,共3页
Chinese Journal of Thoracic and Cardiovascular Surgery
基金
上海市科学技术委员会基金项目资助(024119020)
