中华胸心血管外科杂志
中華胸心血管外科雜誌
중화흉심혈관외과잡지
Chinese Journal of Thoracic and Cardiovascular Surgery
2015年
9期
533-536
,共4页
方敏华%王辉山%汪曾炜%朱洪玉%王镇龙%张春振
方敏華%王輝山%汪曾煒%硃洪玉%王鎮龍%張春振
방민화%왕휘산%왕증위%주홍옥%왕진룡%장춘진
室间隔缺损%肺动脉瓣闭锁%心脏外科手术%肺动脉
室間隔缺損%肺動脈瓣閉鎖%心髒外科手術%肺動脈
실간격결손%폐동맥판폐쇄%심장외과수술%폐동맥
Ventrical septal defect%Pulmonary atresia%Cardiac surgical procedures%Pulmonary artery
目的 评价升主动脉-肺动脉吻合术治疗合并细小肺动脉的伴室间隔缺损的肺动脉闭锁(PA/VSD)的效果.方法 2004年5月至2013年6月,连续51例合并细小肺动脉的PA/VSD患儿行升主动脉-肺动脉吻合术,男37例,女14例;年龄2~ 86个月,平均(23.9 ±21.7)个月;体质量2.5~21.5 kg,平均(9.4±5.3)kg.39例主肺动脉直径小于4 mm,行升主动脉-主肺动脉端-侧吻合术,12例主肺动脉缺如行改良的主动脉-肺动脉吻合术.结果 术后和随访期间无死亡.与术前相比,术后6个月和二次手术前测定肺动脉指数明显增加,(68.8±11.4) mm2/m2对(129.1 ±24.9) mm2/m2,P<0.001;肺动脉指数变化率(术后肺动脉指数-术前肺动脉指数/术前肺动脉指数)27.0%~150.0%,平均(87.7±27.4)%.Logistic逐步回归分析结果显示,手术年龄、主-肺动脉侧支血管数量和手术方式是影响肺动脉指数变化率的独立的相关因素.结论 升主动脉-肺动脉吻合术是一种安全和简单的姑息手术,能促进合并细小肺动脉的PA/VSD患儿自然肺动脉的发育.对于合并肺动脉缺如的患儿,直接左右肺动脉与升主动脉吻合可以减少吻合口的扭曲,减少术后分流堵塞和失效的发生概率.
目的 評價升主動脈-肺動脈吻閤術治療閤併細小肺動脈的伴室間隔缺損的肺動脈閉鎖(PA/VSD)的效果.方法 2004年5月至2013年6月,連續51例閤併細小肺動脈的PA/VSD患兒行升主動脈-肺動脈吻閤術,男37例,女14例;年齡2~ 86箇月,平均(23.9 ±21.7)箇月;體質量2.5~21.5 kg,平均(9.4±5.3)kg.39例主肺動脈直徑小于4 mm,行升主動脈-主肺動脈耑-側吻閤術,12例主肺動脈缺如行改良的主動脈-肺動脈吻閤術.結果 術後和隨訪期間無死亡.與術前相比,術後6箇月和二次手術前測定肺動脈指數明顯增加,(68.8±11.4) mm2/m2對(129.1 ±24.9) mm2/m2,P<0.001;肺動脈指數變化率(術後肺動脈指數-術前肺動脈指數/術前肺動脈指數)27.0%~150.0%,平均(87.7±27.4)%.Logistic逐步迴歸分析結果顯示,手術年齡、主-肺動脈側支血管數量和手術方式是影響肺動脈指數變化率的獨立的相關因素.結論 升主動脈-肺動脈吻閤術是一種安全和簡單的姑息手術,能促進閤併細小肺動脈的PA/VSD患兒自然肺動脈的髮育.對于閤併肺動脈缺如的患兒,直接左右肺動脈與升主動脈吻閤可以減少吻閤口的扭麯,減少術後分流堵塞和失效的髮生概率.
목적 평개승주동맥-폐동맥문합술치료합병세소폐동맥적반실간격결손적폐동맥폐쇄(PA/VSD)적효과.방법 2004년5월지2013년6월,련속51례합병세소폐동맥적PA/VSD환인행승주동맥-폐동맥문합술,남37례,녀14례;년령2~ 86개월,평균(23.9 ±21.7)개월;체질량2.5~21.5 kg,평균(9.4±5.3)kg.39례주폐동맥직경소우4 mm,행승주동맥-주폐동맥단-측문합술,12례주폐동맥결여행개량적주동맥-폐동맥문합술.결과 술후화수방기간무사망.여술전상비,술후6개월화이차수술전측정폐동맥지수명현증가,(68.8±11.4) mm2/m2대(129.1 ±24.9) mm2/m2,P<0.001;폐동맥지수변화솔(술후폐동맥지수-술전폐동맥지수/술전폐동맥지수)27.0%~150.0%,평균(87.7±27.4)%.Logistic축보회귀분석결과현시,수술년령、주-폐동맥측지혈관수량화수술방식시영향폐동맥지수변화솔적독립적상관인소.결론 승주동맥-폐동맥문합술시일충안전화간단적고식수술,능촉진합병세소폐동맥적PA/VSD환인자연폐동맥적발육.대우합병폐동맥결여적환인,직접좌우폐동맥여승주동맥문합가이감소문합구적뉴곡,감소술후분류도새화실효적발생개솔.
Objective The aim was to evaluate the development of pulmonary arteries(PA) in patients with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries by using a central end-to-side shunt between the ascending aorta and pulmonary arteries and to identify the associated factors for the results.Methods 51 consecutive patients(37 male,14 female) with pulmonary atresia,ventricular septal defect and diminutive pulmonary arteries received a central end-to-side shunt between PA and the ascending aorta from May 2004 to June 2013.Ages and weight ranged between 2-86 months and 2.5-21.5 kg,respectively.39 patients with main PA diameters less than 4 mm received the central end-to-side shunt between the ascending aorta and PA,and 14 patients with main pulmonary arteries absence received a modified shunt.Results There were no deaths during operation and follow-up.Compared with preoperative measures,total pulmonary artery index increased from a mean value of(68.8 ± 11.4) mm2/m2 to(129.1 ± 24.9) mm2/m2 (P < 0.001) at the time of six months or the final repair after shunt.The increased pulmonary artery index change was(87.7 ± 27.4) % (27.0% to 150.0%).By multivariate regression analysis,age at shunt,shunt procedure and number of major aortopulmonary collateral arteries were correlated with increasing pulmonary artery index change.Conclusion The central end-to-side shunt between the ascending aorta and pulmonary arteries promoted sufficient growth of the diminutive central pulmonary arteries.Due to the risk of a distortion of pulmonary branches,we interposed a modified procedure for patients with main pulmonary arteries absence.It is technically easy to perform,warrants low risk of shunt thrombosis in the early postoperative period.