中华小儿外科杂志
中華小兒外科雜誌
중화소인외과잡지
CHINESE JOURNAL OF PEDIATRIC SURGERY
2014年
9期
694-697
,共4页
杨晋明%陈瑞%张鸿毅%刘彩霞%智喜强
楊晉明%陳瑞%張鴻毅%劉綵霞%智喜彊
양진명%진서%장홍의%류채하%지희강
肺动脉发育不良%法乐四联症%心脏外科手术
肺動脈髮育不良%法樂四聯癥%心髒外科手術
폐동맥발육불량%법악사련증%심장외과수술
Hypoplasia of pulmonary arteries%Tetralogy of Fallot%Cardiac surgical procedures
目的 探讨肺动脉发育不良型婴幼儿法乐四联症手术适应证.方法 回顾性分析2009年1月至2013年4月间行手术治疗的98例法洛四联症患儿(McGoon≤1.2)的临床资料,收集与肺动脉关联数据,根据术式分为根治术组和体肺分流组.根据影像学资料,分别测定McGoon指数(MI)、左下肺动脉直径/左肺动脉近端直径(LBPA/LPA1)、左下肺动脉直径/左肺动脉远端直径(LBPA/LPA2)、左右下肺动脉直径之和/左右肺动脉近端直径之和(MBPA/MPA1)、左右下肺动脉直径之和/左右肺动脉远端直径之和(MBPA/MPA2)、右下肺动脉/气管(RBPA/TR)及临床数据;通过统计学分析,发现MBPA/MPA1在体肺分流组明显低于根治组,差异有统计学意义(P =0.004),按照MBPA/MPA1 =0.70为界结合McGoon指数将病例分为根治组(82例)、体肺分流组(16例)比较实际病死率.结果 根治组死亡6例,经皮血氧饱和度由术前(73.3±10.2)％升至(95.6±1.8)％,血红蛋白由术前(149.4±30.1)g/L降至(121.6±8.0)g/L.体肺分流组死亡2例,经皮血氧饱和度由术前(67.4±11.8)％升至(84.6±2.2)％,血红蛋白由术前(158.6±32.7)g/L降至(120.8±11.6)g/L,MI由1.0±0.2升至1.2±0.1.LBPA/LPA1在体肺分流组为0.6±0.1,明显低于根治组0.8±0.1;MBPA/MPA1在体肺分流组为0.6±0.1,明显低于根治组0.8±0.1,差异均有统计学意义(P =0.004);MI和MBPA/MPA1相结合的分组的实际根治病死率明显降低.结论 对于大多MI≤1.2的肺动脉发育不良型法乐四联症患儿可早期行法乐四联症根治术.MBPA/MPA1可能可以更好的反映肺内血管发育情况,而MI和MBPA/MPA1相结合能为法乐四联症根治手术适应证的选择提供重要依据.
目的 探討肺動脈髮育不良型嬰幼兒法樂四聯癥手術適應證.方法 迴顧性分析2009年1月至2013年4月間行手術治療的98例法洛四聯癥患兒(McGoon≤1.2)的臨床資料,收集與肺動脈關聯數據,根據術式分為根治術組和體肺分流組.根據影像學資料,分彆測定McGoon指數(MI)、左下肺動脈直徑/左肺動脈近耑直徑(LBPA/LPA1)、左下肺動脈直徑/左肺動脈遠耑直徑(LBPA/LPA2)、左右下肺動脈直徑之和/左右肺動脈近耑直徑之和(MBPA/MPA1)、左右下肺動脈直徑之和/左右肺動脈遠耑直徑之和(MBPA/MPA2)、右下肺動脈/氣管(RBPA/TR)及臨床數據;通過統計學分析,髮現MBPA/MPA1在體肺分流組明顯低于根治組,差異有統計學意義(P =0.004),按照MBPA/MPA1 =0.70為界結閤McGoon指數將病例分為根治組(82例)、體肺分流組(16例)比較實際病死率.結果 根治組死亡6例,經皮血氧飽和度由術前(73.3±10.2)％升至(95.6±1.8)％,血紅蛋白由術前(149.4±30.1)g/L降至(121.6±8.0)g/L.體肺分流組死亡2例,經皮血氧飽和度由術前(67.4±11.8)％升至(84.6±2.2)％,血紅蛋白由術前(158.6±32.7)g/L降至(120.8±11.6)g/L,MI由1.0±0.2升至1.2±0.1.LBPA/LPA1在體肺分流組為0.6±0.1,明顯低于根治組0.8±0.1;MBPA/MPA1在體肺分流組為0.6±0.1,明顯低于根治組0.8±0.1,差異均有統計學意義(P =0.004);MI和MBPA/MPA1相結閤的分組的實際根治病死率明顯降低.結論 對于大多MI≤1.2的肺動脈髮育不良型法樂四聯癥患兒可早期行法樂四聯癥根治術.MBPA/MPA1可能可以更好的反映肺內血管髮育情況,而MI和MBPA/MPA1相結閤能為法樂四聯癥根治手術適應證的選擇提供重要依據.
목적 탐토폐동맥발육불량형영유인법악사련증수술괄응증.방법 회고성분석2009년1월지2013년4월간행수술치료적98례법락사련증환인(McGoon≤1.2)적림상자료,수집여폐동맥관련수거,근거술식분위근치술조화체폐분류조.근거영상학자료,분별측정McGoon지수(MI)、좌하폐동맥직경/좌폐동맥근단직경(LBPA/LPA1)、좌하폐동맥직경/좌폐동맥원단직경(LBPA/LPA2)、좌우하폐동맥직경지화/좌우폐동맥근단직경지화(MBPA/MPA1)、좌우하폐동맥직경지화/좌우폐동맥원단직경지화(MBPA/MPA2)、우하폐동맥/기관(RBPA/TR)급림상수거;통과통계학분석,발현MBPA/MPA1재체폐분류조명현저우근치조,차이유통계학의의(P =0.004),안조MBPA/MPA1 =0.70위계결합McGoon지수장병례분위근치조(82례)、체폐분류조(16례)비교실제병사솔.결과 근치조사망6례,경피혈양포화도유술전(73.3±10.2)％승지(95.6±1.8)％,혈홍단백유술전(149.4±30.1)g/L강지(121.6±8.0)g/L.체폐분류조사망2례,경피혈양포화도유술전(67.4±11.8)％승지(84.6±2.2)％,혈홍단백유술전(158.6±32.7)g/L강지(120.8±11.6)g/L,MI유1.0±0.2승지1.2±0.1.LBPA/LPA1재체폐분류조위0.6±0.1,명현저우근치조0.8±0.1;MBPA/MPA1재체폐분류조위0.6±0.1,명현저우근치조0.8±0.1,차이균유통계학의의(P =0.004);MI화MBPA/MPA1상결합적분조적실제근치병사솔명현강저.결론 대우대다MI≤1.2적폐동맥발육불량형법악사련증환인가조기행법악사련증근치술.MBPA/MPA1가능가이경호적반영폐내혈관발육정황,이MI화MBPA/MPA1상결합능위법악사련증근치수술괄응증적선택제공중요의거.
Objective To explore the operative indications for Tetralogy of Fallot (TOF) with hypoplasia of pulmonary arteries in infants and children.Methods From January 2009 to April 2013,98 patients with TOF and hypoplasia of pulmonary arteries (McGoon index,MI≤1.2) were analyzed retrospectively.According to surgical procedures,they were divided into two groups of radical operation and systemic-to-pulmonary artery shunt.According to the data of medical imaging,we calculated McGoon index,ratio of inferior left branch of pulmonary artery to proximal left pulmonary artery (LBPA/LPA1),ratio of inferior left branch of pulmonary artery to remote left pulmonary artery (LBPA/LPA2),ratio of sum of inferior branches of left and right pulmonary arteries to sum of proximal left and right pulmonary arteries (MBPA/MPA1),ratio of sum of inferior branches of left and right pulmonary arteries to sum of remote left and right pulmonary arteries (MBPA/MPA2),ratio of inferior branches of right pulmonary arteries to trachea and clinical data.By statistic analyses,MBPA/MPA1 in systemic-to-pulmonary artery shunt group was much lower than that of radical operation group (P =0.004).Ratio of MBPA/MPA1 =0.70 was regarded as the dividing line,combined with McGoon index,all cases were re-grouped and actual mortality of each group was compared.Results Six patients died in radical group (6/82) versus 2 in systemic-to-pulmonary artery shunt group (2/16).In radical group,percutaneous oxygen saturation obviously improved from (73.3± 10.2) ％ to (95.6 ± 1.8) ％ and hemoglobin markedly decreased from (149.4 ± 30.1)g/L to (121.6 ± 8.0) g/L; In systemic-to-pulmonary artery shunt group:percutaneous oxygen saturation obviously improved from (67.4 ± 11.8)％ to (84.6 ± 2.2)％,hemoglobin markedly decreased from (158.6 ± 32.7) to (120.8 ± 11.6)g/L and MIobviously improved from 1.0 ± 0.2 to 1.2 ± 0.1.LBPA/LPA1 in systemic-to-pulmonary artery shunt group was much lower than that of radical operation group (0.6 ± 0.2 vs.0.8 ± 0.1,P＜0.05).The MBPA/MPA1 in systemic to pulmonary artery shunt group was also much lower than that of radical operation group (0.6 ± 0.1 vs.0.8 ± 0.1,P =0.004).The actual mortality in radical operation group obviously decreased after re-grouping according to the MBPA/MPA1 plus MI.Conclusions Most patients with TOF and hypoplasia of pulmonary arteries (MI≤1.2)may undergo radical operation.MBPA/MPA1 probably better reflects the development of pulmonary vessels.Moreover,MBPA/MPA1 plus MI offer an important indication for radical operation.
