小儿主-肺动脉间隔缺损的外科治疗  

Surgical correction of aortopulmonary septal defect in children

作　　者：曹鼎方[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2004年第4期196-198,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　总结小儿主 -肺动脉间隔缺损 (APSD)的外科治疗经验。方法　 15例APSD ,年龄 5个月～ 11岁 ,体重 4 5～ 2 1 0kg。按Richardson分型 ,I型 7例 ,II型 3例 ,III型 5例。 8例合并其他心脏畸形 ,其中 4例合并复杂畸形 (2 6 7% )。 8例I及II型用补片修补缺损 ;3例III型将人工血管剪成半圆柱形 ,在主动脉内作内隧道 ,连接右肺动脉 (RPA)和APSD ;1例III型行人工血管RPA 肺动脉干连接术 ;1例III型用切下一片主动脉壁延伸RPA至APSD ;2例直接切开缝合。合并心脏畸形同时予以纠治。结果　手术死亡 1例 (6 7% )。 11例随访 3个月～ 13年 ,恢复良好。结论　APSD合并复杂心脏畸形较易漏诊 ,二维多普勒超声检查 ,结合心导管和心血管造影以及磁共振检查可明确诊断。一经诊断应及早手术 ,手术年龄以婴儿早期为佳 ,以免产生肺血管疾病。III型APSD及APSD合并复杂心脏畸形是手术死亡的主要原因 ,术前明确诊断 ,充分认识病理生理是纠治术成功的关键。Objective To summarize experiences of surgical correction of aortopulmanary septal defect (APSD) in children. Methods Fifteen children with APSD,aged 5 months to 11 years,weighed 4.5 to 21.0kg,underwent surgical correction. Based on Richardson's classification,type I in 7 cases,type II in 3,and type III in 5. Eight cases were associated with other cardiac defects (53.5%),including 4 cases with complicated cardiac defects (26.7%). Operative technique included patch repair of defect in 8 cases with type I and II,an intraaotic synthetic baffle directed pulmonary blood from the APSD to the right pulmonary artery (RPA) in 3 cases with type III,an artificial conduit was used to connect the RPA with main pulmonary artery (MPA) and a flap of aortic wall was excised along with the anomalous RPA to extend the anastomosis in each case with type III,direct suture was used in 2 cases. Other associated cardiac defects were repaired simultaneously. Results The post-operative mortality rate was 6.7% (1/15). Eleven cases were followed-up from 3 months to 13 years in good condition. Conclusion APSD associated with complicated cardiac defects is apt to be misdiagnosed. Correct diagnosis can be made by 2-D echocardiography, cardiac catheterization angiography,and MRI. The operation should be done as early as possible once definite diagnosis is made. Operation should be done infancy to prevent development of pulmonary vascular disease. In type III APSD and APSD associated with complicated cardiac defects,operative mortalith is high. Preoperative accurate diagnosis and full understanding of the pathophysiology are the keys to an optimal surgical correction.

关 键 词：小儿 主-肺动脉间隔缺损 外科治疗 先天性心脏病 

分 类 号：R726.5[医药卫生—儿科]