摘要
目的 探讨小儿重度肺动脉瓣狭窄的外科治疗。方法 93例重度肺动脉瓣狭窄患儿中 ,在非体外循环下行纠治术 14例 (闭式肺动脉瓣扩张术 3例 ,低温腔静脉阻断下肺动脉瓣切开术 11例 ) ,在平行体外循环下行纠治术 79例 (肺动脉瓣切开术 5 8例 ,右室流出道跨瓣环心包补片扩大术 2 1例 )。 8例伴动脉导管未闭者3例予以结扎 ,5例仍保持开放。 1例术后 1d再行右侧B T分流术。结果 手术死亡 3例 ,残余梗阻 17例。结论 体外循环下治疗小儿重度肺动脉瓣狭窄具较高安全性 ;对有右室流出道梗阻者采用右室流出道跨瓣环心包补片扩大术较肺动脉瓣交界切开术更具优越性 ;对伴有右心室发育不良的患儿 。
Objective To evaluate the results of operative management of severe pulmonary valve stenosis. Methods In 93 cases of severe pulmonary valve stenosis, 14 cases underwent surgical treatment without cardiopulmonary bypass. (Closed transventricular valvotomy was performed in 3 cases, Open valvotomy with inflow occlusion with the use of hypothermia was performed in 11 cases). 79 cases underwent surgical treatment on cardiopulmonary bypass with hypothermia or normothermia. (Pulmonary valvotomy in 58 cases. Transannular right ventricular outflow tract with pericardium patch enlargement in 21 cases). 8 cases were associated with PDA, among them 3 were ligated during operation, 5 PDA was still kept open because of low blood oxygen saturation. One patient without PDA underwent Blalock-Taussig shunt on the next day for the same reason. Results There were 3 deaths and 17 had residual RVOT obstruction. Conclusion Surgical treatment with cardiopulmonary bypass is safer and more effective for some cases of severe pulmonary valve stenosis than percutaneous balloon pulmonary valvuloplasty. Transannular RVOT pericardium patch enlargement gives more satisfactory results than pulmonary valvotomy in patient with RVOT obstruction. It is necessary for patients with right ventricular hypoplasia to perform systemic pulmonery shunt or keep PDA open when stenosis is completely relieved.
出处
《上海医学》
CAS
CSCD
北大核心
2001年第1期11-13,共3页
Shanghai Medical Journal
关键词
肺动脉瓣狭窄
儿童
外科手术
Pulmonary valve stenosis
Surgical treatment
