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[1]梅 闯,白云鹏,王 强,等.肺动脉闭锁合并室间隔缺损不同术式的疗效分析[J].天津医科大学学报,2019,25(06):627-630+637.
 MEI Chuang,BAI Yun-peng,WANG Qiang,et al.Efficacy ananlysis of different surgical methods for pulmonary atresia with ventricular septal defect[J].Journal of Tianjin Medical University,2019,25(06):627-630+637.
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《天津医科大学学报》[ISSN:1006-8147/CN:12-1259/R]

卷:
25
期数:
2019年06期
页码:
627-630+637
栏目:
临床医学
出版日期:
2019-11-20

文章信息/Info

Title:
Efficacy ananlysis of different surgical methods for pulmonary atresia with ventricular septal defect
文章编号:
1006-8147(2019)06-0627-05
作者:
梅 闯1白云鹏2王 强2刘建实2
(1.天津医科大学研究生院,天津300070;2.天津市胸科医院心外科,天津300350)
Author(s):
MEI Chuang1BAI Yun-peng2WANG Qiang2LIU Jian-shi2
(1.Graduate School, Tianjin Medical University, Tianjin 300070,China;2.Department of Cardiovascular Surgery,Tianjin Chest Hospital, Tianjin 300350, China)
关键词:
肺动脉闭锁室间隔缺损肺动脉发育手术方式
Keywords:
pulmonary atresiaventricular septal defectpulmonary artery development surgical methods
分类号:
R541.1
DOI:
-
文献标志码:
A
摘要:
目的:比较分析不同术式在肺动脉闭锁合并室间隔缺损(PA/VSD)治疗中的手术效果。方法:回顾性分析2006年9月至2017年9月天津市胸科医院心外科诊治的25例B型肺动脉闭锁合并室间隔缺损患儿(者)的临床资料。其中男16例,女9例;年龄2d~26.4岁;体质量3.5~46.0 kg。根据选取的手术方式的不同,将25例病人分为两组:姑息手术组和根治手术组。收集两组患儿(者)术前、术中和术后的各项相关资料和指标进行比较分析。结果:术后早期死亡2例(6.9%),均来自根治组。两组死亡差异无统计学意义,P=0.07。死亡原因1例考虑为呼吸衰竭,另1例为低心排综合征。术后肺部感染3例,吻合口出血行二次开胸止血1例,手术切口愈合不良1例,术后左肺动脉较术前狭窄1例。术后随访10个月~8年,失访1例。随访期间,测定肺动脉指数均有不同程度的增加。姑息组中共有5例最终完成根治术。结论:不同术式治疗肺动脉闭锁合并室间隔缺损安全有效。早期建立肺动脉前向血流对于肺动脉的发育有重要的促进作用。术前应综合评估肺动脉的形态发育和侧支血管的解剖情况,选择相应的个体化的手术方式。
Abstract:
Objective: To compare and analyze the surgical outcomes of different surgical methods in the treatment of pulmonary atresia with ventricular septal defect(PA/VSD). Methods: We restrospectively analyzed the clinical data of 25 patients with type B PA/VSD who underwent surgical procedures in the Department of Cardiovascular Surgery, Tianjin Chest Hospital from September 2006 to September 2017, including 16 males and 9 females:2 days ~ 26.4 years old, body weight: 3.5 ~ 46.0kg. And,according to the different surgical methods selected, patients were further divided into two groups: palliative surgery group and radical surgery group.The clinical data and indicators of the two groups before, during and after operation were collected for comparative analysis. Results:Early postoperative mortality was 2(6.9%),both in the radical group.There was no significant difference between the two groups in mortality(P=0.07).The cause of death was respiratory failure in one case and low cardiac output syndrome in the other.Postoperative complicants included pulmonary infection(n=3), re-exploration for anastomotic bleeding(n=1),bad healing of surgical incision(n=1),left pulmonary artery stenosis compared with preoperative(n=1). Follow-up ranged from 10 months to 8 years with 1 cases missing.During the follow-up,total pulmonary artery index increased by different degrees.In the palliative group,5 cases completed radical operation. Conclusion:Different surgical methods are safe and effective for different types of pulmonary atresia with ventricular septal defect. Early establishment of pulmonary artery anterior blood flow plays an important role in promoting pulmonary artery development.It is necessary to preoperative evaluate the morphological development of the pulmonary artery and the anatomy of the MAPCAs comprehensively,and select the individualized surgical method.

参考文献/References:

[1] Carotti A, Albanese S B, Di Donato R M. Unifocalization and repair of pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries[J]. Acta Paediatr Suppl, 2006, 95(452):22
[2] Tchervenkov C, Roy N. Congenital heart surgery nomenclature and database project: pulmonary atresia-ventricular septal defect[J]. Ann Thorac Surg, 2000, 69(4 Suppl):97
[3] Cho J M, Puga F J, Danielson G K, et al. Early and long-term results of the surgical treatment of tetralogy of Fallot with pulmonary atresia, with or without major aortopulmonary collateral arteries[J]. J Thorac Cardiovasc Surg, 2002,124(1):70
[4] 邓喜成, 李守军. 肺动脉闭锁合并室间隔缺损的外科治疗策略[J]. 中国胸心血管外科临床杂志, 2010,17(1):50
[5] Nakata S, Imai Y, Takanashi Y, et al. A new method for the quantitative standardization of cross-sectional areas of the pulmonary arteries in congenital heart diseases with decreased pulmonary blood flow[J]. J Thorac Cardiovasc Surg, 1984,88(4):610
[6] Reddy V M, Petrossian E, McElhinney D B, et al. One-stage complete unifocalization in infants: when should the ventricular septal defect be closed?[J]. J Thorac Cardiovasc Surg, 1997,113(5):858
[7] Ishibashi N, Shin'oka T, Ishiyama M, et al. Clinical results of staged repair with complete unifocalization for pulmonary atresia with ventricular septal defect and major aortopulmonary collateral arteries[J]. Eur J Cardiothorac Surg, 2007,32(2):202
[8] Miyamoto T, Nobuhiro N, Kagami M, et al. Cavopulmonary connection after repair of no confluent pulmonary atresia and total anomalous pulmonary venous connection[J]. J Thorac Cardiovasc Surg, 2003, 125(3):731
[9] Gerelli S, van Steenberghe M, Murtuza B, et al. Neonatal right ventricle to pulmonary connection as a palliative procedure for pulmonary atresia with ventricular septal defect or severe tetralogy of Fallot[J]. Eur J Cardiothorac Surg, 2014,45(2):278
[10] Yuan S M, Shinfeld A, Raanani E. The Blalock-Taussig shunt[J]. J Card Surg, 2009,24(2):101
[11] Gedicke M, Morgan G, Parry A, et al. Risk factors for acute shunt blockage in children after modified Blalock-Taussig shunt operations[J]. Heart Vessels, 2010,25(5):405
[12] Kim H, Sung S C, Choi K H, et al. A central shunt to rehabilitate diminutive pulmonary arteries in patients with pulmonary atresia with ventricular septal defect[J]. J Thorac Cardiovasc Surg, 2015, 149(2):515
[13] 施怡声, 王浩, 李建蓉, 等. 超声心动图对体肺分流术的评价和随访[J]. 中国循环杂志, 2009,24(6):454
[14] 方敏华, 王辉山, 汪曾炜, 等. 升主动脉-肺动脉吻合术治疗伴室间隔缺损的肺动脉闭锁患儿的效果[J]. 中华胸心血管外科杂志, 2015,31(9):533
[15] Bockeria L A, Podzolkov V P, Makhachev O A, et al. Palliative surgical treatment of congenital heart defects associated with unilateral absence of the pulmonary artery[J]. Interact Cardiovasc Thorac Surg, 2013,16(3):286
[16] Fiore A C, Tobin C, Jureidini S, et al. A comparison of the modified Blalock-Taussig shunt with the right ventricle-to-pulmonary artery conduit[J]. Ann Thorac Surg, 2011,91(5):1479
[17] Amark K M, Karamlou T, O’Carroll A, et al. Independent factors associated with mortality, reintervention, and achievement of complete repair in children with pulmonary atresia with ventricular septal defect[J]. J Am Coll Cardiol, 2006,47(7):1448
[18] 张永辉, 花中东, 王旭, 等. 不同姑息性手术对肺动脉闭锁合并室间隔缺损患者肺血管发育促进作用的比较[J]. 中国循环杂志, 2018,33(11):1108
[19] 鲁中原, 李守军, 王旭, 等. 体-肺动脉分流与右心室肺动脉连接术治疗肺动脉闭锁合并室间隔缺损术后早期疗效的对比研究[J]. 中国胸心血管外科临床杂志, 2014,21(4):468
[20] De Giovanni J V. Timing, frequency, and results of catheter intervention following recruitment of major aortopulmonary collaterals in patients with pulmonary atresia and ventricular septal defect[J]. J Interv Cardiol, 2004,17(1):47
[21] Fouilloux V, Bonello B, Kammache I, et al. Management of patients with pulmonary atresia, ventricular septal defect, hypoplastic pulmonary arteries and major aorto-pulmonary collaterals: Focus on the strategy of rehabilitation of the native pulmonary arteries[J]. Arch Cardiovasc Dis, 2012,105(12):666

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备注/Memo

备注/Memo:
作者简介 梅闯(1992-),男,硕士在读,研究方向:复杂先天性心脏病、冠心病及心脏瓣膜病等外科治疗研究;通信作者:刘建实,E-mail: jianshiliu@aliyun.com。
更新日期/Last Update: 2020-01-20