中国医师进修杂志
中國醫師進脩雜誌
중국의사진수잡지
CHINESE JOURNAL OF POSTGRADUATES OF MEDICINE
2009年
20期
33-35
,共3页
法洛四联症%介入治疗%体肺侧支血管
法洛四聯癥%介入治療%體肺側支血管
법락사련증%개입치료%체폐측지혈관
Tetralogy of Fallot%Interventional therapy%Major aortopulmonary collateral vessel
目的 评价手术联合介入封堵体肺动脉侧支矫治法洛四联症的临床应用价值.方法 2004年10月至2008年5月,采取手术联合介入封堵大的体肺动脉侧支矫治法洛四联症8例.心血管造影诊断体肺动脉侧支血管25支,行介入封堵20支,其余5支侧支血管较细,未作处理.手术均采用中度低温体外循环下进行,采用涤纶补片修复室间隔缺损,右心室流出道彻底疏通.结果 全组患者无围手术期死亡,无肺部严重渗出、肾衰竭、严重低心排血量综合征等并发症,也无介入封堵相关并发症,发生低氧血症1例,经治疗后恢复正常.术后随访6个月,NYHA心功能分级Ⅰ级7例,Ⅱ级1例.结论 介入封堵体肺动脉侧支与心内矫治手术联合治疗伴有大的体肺动脉侧支的法洛四联症,能减少回心血流量,利于手术操作,进而提高一期根治的成功率.
目的 評價手術聯閤介入封堵體肺動脈側支矯治法洛四聯癥的臨床應用價值.方法 2004年10月至2008年5月,採取手術聯閤介入封堵大的體肺動脈側支矯治法洛四聯癥8例.心血管造影診斷體肺動脈側支血管25支,行介入封堵20支,其餘5支側支血管較細,未作處理.手術均採用中度低溫體外循環下進行,採用滌綸補片脩複室間隔缺損,右心室流齣道徹底疏通.結果 全組患者無圍手術期死亡,無肺部嚴重滲齣、腎衰竭、嚴重低心排血量綜閤徵等併髮癥,也無介入封堵相關併髮癥,髮生低氧血癥1例,經治療後恢複正常.術後隨訪6箇月,NYHA心功能分級Ⅰ級7例,Ⅱ級1例.結論 介入封堵體肺動脈側支與心內矯治手術聯閤治療伴有大的體肺動脈側支的法洛四聯癥,能減少迴心血流量,利于手術操作,進而提高一期根治的成功率.
목적 평개수술연합개입봉도체폐동맥측지교치법락사련증적림상응용개치.방법 2004년10월지2008년5월,채취수술연합개입봉도대적체폐동맥측지교치법락사련증8례.심혈관조영진단체폐동맥측지혈관25지,행개입봉도20지,기여5지측지혈관교세,미작처리.수술균채용중도저온체외순배하진행,채용조륜보편수복실간격결손,우심실류출도철저소통.결과 전조환자무위수술기사망,무폐부엄중삼출、신쇠갈、엄중저심배혈량종합정등병발증,야무개입봉도상관병발증,발생저양혈증1례,경치료후회복정상.술후수방6개월,NYHA심공능분급Ⅰ급7례,Ⅱ급1례.결론 개입봉도체폐동맥측지여심내교치수술연합치료반유대적체폐동맥측지적법락사련증,능감소회심혈류량,리우수술조작,진이제고일기근치적성공솔.
Objective To demonstrate clinical value of surgical repair combined with collateral embolization for tetralogy of Fallot with major aortopulmonary collateral arteries (MAPCAs).Methods The clinical catheterization and surgical data of 8 such patients from October 2004 to May 2008 were analyzed retrospectively.All 8 patients underwent completely surgical repair combined with MAPCAs occlusion.Of 25 collateral arteries,20 were occluded before surgical procedure and 5 small ones were left.Corrective repairs were accomplished under moderate hypothermic cardiopulmonary bypass.Ventricular septal defect was closed with Dacron patch,and all patients underwent non-valved autologous right ventricular outflow tract reconstruction.Results No complications were observed,only 1 patient got hypoxemia.Blood returned to left atrium from lung was decreased.During 6 months follow-up,7 cases were in NYHA class Ⅰ,another was in NYHA class Ⅱ.Conclusions In selective patients with dual pulmonary blood supply by both MAPCAs and native pulmonary arteries,this combined therapy of collateral embolization and surgical repair simplifies copmpleling surgical procedure,improves surgical results and achieves higher rate of one-stage repair.
