CAJ | 학술논문

目的评价右肺动脉异常起源于主动脉(AORPA)的诊断、治疗方法及效果.方法回顾性分析1992年5月至2007年7月北京安贞医院14例AORPA患者术前诊断及手术治疗疗效资料.12例患者分别采用右全肺切除术、右肺动脉经人工血管或同种主动脉与主肺动脉吻合术、右肺动脉与主肺动脉直接吻合术、双片法右肺动脉与主肺动脉吻合术,同期修补合并畸形.结果 8例单纯超声心动图检查者中漏诊2例,6例右心室及主动脉造影和多排CTA/MRI检查者中无漏诊.2例因艾森曼格综合征未行手术,12例手术者围术期死亡2例.术后随访(5.15±3.48)年,晚期死亡1例,生存9例患者超声心动图复查左心室射血分数43%～52%,2例右肺动脉吻合口狭窄.心功能Ⅰ级5例,Ⅱ级4例.结论右心室及主动脉造影或多排CTA/MRI检查可减少AORPA漏诊室.手术治疗AORPA的早期及中长期效果较好,但应尽早手术以提高疗效.自体组织加宽或加长右肺动脉进行右肺动脉重建术式吻合口狭窄的概率优于应用非自体组织重建右肺动脉术式.
목적 평개우폐동맥이상기원우주동맥(AORPA)적진단、치료방법급효과.방법 회고성분석1992년5월지2007년7월북경안정의원14례AORPA환자술전진단급수술치료료효자료.12례환자분별채용우전폐절제술、우폐동맥경인공혈관혹동충주동맥여주폐동맥문합술、우폐동맥여주폐동맥직접문합술、쌍편법우폐동맥여주폐동맥문합술,동기수보합병기형.결과 8례단순초성심동도검사자중루진2례,6례우심실급주동맥조영화다배CTA/MRI검사자중무루진.2례인애삼만격종합정미행수술,12례수술자위술기사망2례.술후수방(5.15±3.48)년,만기사망1례,생존9례환자초성심동도복사좌심실사혈분수43%～52%,2례우폐동맥문합구협착.심공능Ⅰ급5례,Ⅱ급4례.결론 우심실급주동맥조영혹다배CTA/MRI검사가감소AORPA루진실.수술치료AORPA적조기급중장기효과교호,단응진조수술이제고료효.자체조직가관혹가장우폐동맥진행우폐동맥중건술식문합구협착적개솔우우응용비자체조직중건우폐동맥술식.
Objective To investigate the diagnosis of aortic origin of the right pulmonary artery (AORPA) and evaluate the efficacy of surgical treatment therefore. Methods The clinical data of 14 AORPA patients, 9 male and 5 female, aged 4 (60 days -23 years), hospitalized from May 1992 to March 2007, twelve of which were surgically treated through 5 different procedure, and two of which were denied surgical procedure due to Eisenmenger syndrome. Follow-up was conducted for(5.15±3.48)years. Results The diagnosis of 12 out of the 14 patients was confirmed before operation, and 2 of them were misdiagnased by echocardiography. Two patients died during the peri-operational period due to low output syndrome or pulmonary hypertension crisis. One patient died from right cardiac failure 4 yrs after the surgical procedure. Of the 9 surviving patients, 5 were in NYHA functional class Ⅰ, and 4 in class Ⅱ . Conclusion In diagnosis of AORPA right ventriculography and aortic angiography or multi-sliced CT angiography or MRI are necessary to avoid misdiagnosis. The early and mid-long term effects of surgical treatment for AORPA are good, but it was imperative to adopt these procedures as early as possible to heighten the cure efficacy.