中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2009年
1期
20-24
,共5页
宓亚平%贾兵%李炘%叶明%陈张根
宓亞平%賈兵%李炘%葉明%陳張根
복아평%가병%리흔%협명%진장근
肺动脉瓣闭锁%心脏外科手术%心脏病%先天性
肺動脈瓣閉鎖%心髒外科手術%心髒病%先天性
폐동맥판폐쇄%심장외과수술%심장병%선천성
Pulmonary atresia%Cardiac surgical procedures%Heart diseases,congenital
目的 总结室间隔完整型肺动脉闭锁的治疗策略.方法 1994年1月至2008年1月,31例室间隔完整型肺动脉闭锁行手术治疗,男 23 例,女 8 例,年龄20 h至3岁,体重2.9～12.5kg.手术包括体肺分流 5 例,闭式肺动脉瓣切开 4 例(联合体肺分流 2 例),跨瓣补片 18 例(联合体肺分流 12 例),双向腔肺分流术 4 例.根据手术时间分为A组(1994至2003年,13 例)和B组(2004年至今,18 例).结果 住院死亡 8 例(8/31,25.81%),B组病死率明显低于A组(2/18 vs 6/13,P<0.01).不同手术阶段(r=0.40,P=0.03)、手术前已机械通气(r=0.56,P=0.001)等因素与手术病死率有关.结论 室间隔完整型肺动脉闭锁治疗方案需个体化,加强心功能支持和随访以获得满意生存率.
目的 總結室間隔完整型肺動脈閉鎖的治療策略.方法 1994年1月至2008年1月,31例室間隔完整型肺動脈閉鎖行手術治療,男 23 例,女 8 例,年齡20 h至3歲,體重2.9～12.5kg.手術包括體肺分流 5 例,閉式肺動脈瓣切開 4 例(聯閤體肺分流 2 例),跨瓣補片 18 例(聯閤體肺分流 12 例),雙嚮腔肺分流術 4 例.根據手術時間分為A組(1994至2003年,13 例)和B組(2004年至今,18 例).結果 住院死亡 8 例(8/31,25.81%),B組病死率明顯低于A組(2/18 vs 6/13,P<0.01).不同手術階段(r=0.40,P=0.03)、手術前已機械通氣(r=0.56,P=0.001)等因素與手術病死率有關.結論 室間隔完整型肺動脈閉鎖治療方案需箇體化,加彊心功能支持和隨訪以穫得滿意生存率.
목적 총결실간격완정형폐동맥폐쇄적치료책략.방법 1994년1월지2008년1월,31례실간격완정형폐동맥폐쇄행수술치료,남 23 례,녀 8 례,년령20 h지3세,체중2.9～12.5kg.수술포괄체폐분류 5 례,폐식폐동맥판절개 4 례(연합체폐분류 2 례),과판보편 18 례(연합체폐분류 12 례),쌍향강폐분류술 4 례.근거수술시간분위A조(1994지2003년,13 례)화B조(2004년지금,18 례).결과 주원사망 8 례(8/31,25.81%),B조병사솔명현저우A조(2/18 vs 6/13,P<0.01).불동수술계단(r=0.40,P=0.03)、수술전이궤계통기(r=0.56,P=0.001)등인소여수술병사솔유관.결론 실간격완정형폐동맥폐쇄치료방안수개체화,가강심공능지지화수방이획득만의생존솔.
Objective To evaluate the clinical treatment courses, outcomes and follow-up for the pulmonary atresia with intact ventricular septum (PAIVS) in our center, and to delineate strate- gies for the optimal management of PAIVS. Methods From January 1994 to January 2008, 31 con- secutive infants (23 males and 8 females) with PAIVS underwent surgical treatment. Mean age at op- eration was 106.88 days (ranged from 20 hours to 3 years). Mean weight was 4.71kg (ranged from 2.9kg to 12.5kg). Six cases were complicated with severe maldevelopment of right ventricle, 5 with patency of sinusoid, 2 with Ebstcin malformation, 1 with atresia of tricuspid valve(TV), 3 with ste- nosis of TV, and 3 with maldevelopment of TV. Initial surgical treatment included: five Blalock-Taus- sig shunt (BT shunt), 2 closed pulmonary valvotomy (CPV), 2 CPV and BT shunt, 6 right ventricu- lar outlet tract rcconstruction (RVOTR), 12 RVOTR and BT shunt and 4 Bidirectional cavopulmonary connection. The patients were divided into two groups based on the timing of operation: group A (1994 to 2003, 13 cases)and group B (2004 to now, 18 cases). Results Mean duration of mechanical ventilation and intensive care unit stay were 1.98 ± 1.78 days and 6.42 ± 5.98 days,and mean length of stay was 16.12 ± 9.27 days, respectively. There were totally eight patients died during hospitaliza- tion(8/31,25.81%). Mortality of group B was significantly lower than that of group A(2/18 vs 6/13, P<0.01). Multivariable analyses demonstrated that the timing of operation (r=0.40, P=0.03)and mechanical ventilation before surgical treatment(r=0. 56, P=0.001 )could be the risk factors for in- hospital mortality. Twenty-one cases were followed up at the average period of 20 months (ranged from 2 months to 7 years). Conclusions Patients with PAIVS should undergo appropriate operations in time based on individual conditions, such as the size of tricuspid valve, the shape of right ventricle and malformation of coronary artery, which can help achieve excellent short-term outcomes. Postoper- ative survival rate can be achieved by optimizing operations, reinforcing the cardiac function support in perioperative period and prolonging follow-up period.
