自体心包跨环补片在右心室流出道重建中的应用  

Simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in right ventricular outflow tract reconstruction

作　　者：刘学刚[1] 王祖义[1] 武开宏[1] 史向前[1] 唐震[1] 刘以尧[1] 

机构地区：[1]蚌埠医学院附属医院胸心外科,安徽233004

出　　处：《中华胸心血管外科杂志》2004年第4期199-201,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨自体心包同时扩大肺动脉瓣环与瓣膜的跨环补片技术在右心室流出道(RVOT)重建术中的应用效果。方法　 2 5例肺动脉发育较差的先天性心脏病病人在行心室矫治和RVOT重建术中 ,按跨环补片手术方法 ,13例为自体心包同时扩大肺动脉瓣环与瓣膜的跨环补片组 (试验组 ) ;12例同期行常用的心包带瓣或不带瓣跨环补片组 (对照组 )。比较两组手术前、后主要临床及随访资料。结果　两组无手术死亡和再手术病例。术毕测右心室与左心室收缩压比值及右房压力 ,术后观察多巴胺用量及肺动脉瓣反流等指标 ,两组比较差异均有显著性 (P <0 0 5 ,P <0 0 1) ,试验组明显优于对照组。结论　采用自体心包同时扩大肺动脉瓣环与瓣膜的跨环补片技术重建RVOT ,可取得满意的防止肺动脉瓣反流的早期手术疗效。操作简单、取材方便、易于掌握 ,可作为RVOT重建术的很好补充 ,有一定的应用价值 ,但瓣膜功能远期效果有待于进一步观察。Ovbective To evaluate the clinical results of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium in right ventricular outflow tract(RVOT)reconstruction. Methods From Jan.2003 to Jan.2004,Twenty-five patients who have complex congenital heart anomalies with pulmonary artery hypoplasia received surgical correction with RVOT reconstruction were randomly divided into research group (n=13) and control group (n=12). The patients in the research group used the technique of simultaneous enlargement of the pulmonary annulus and the pulmonary cusp with a transannular patch of autologous pericardium,routine technique of a transannular patch with or without a autologus pericardial monocuspid valve was used in control group. The main clinical characteristics and follow up data were studied and compared. The degree of pulmonary insufficiency was evaluated before discharge,at 3～6 months,and at 12months after the operation. Results There was no operative mortality in two groups. Compared with control group,the mean right ventricle to left ventricle systolic pressure ratio,right atrial pressure,maximum doses of dopamine and correction of pulmonary insufficiency were improved significantly (P<0.05,P< 0.01 ) in research group. None of these patients repaired reoperation. Conclusion The surgical technique of the RVOT reconstruction with simultaneous enlargement of the pulmonary annulus and the pulmonary cusp using a transannular patch of autologous pericardium provides excellent early results for the prevention of pulmonary insufficiency. This easily constructed valve can be used as an adjunct to RVOT reconstruction. However further close follow-up is needed.

关 键 词：自体心包跨环补片 右心室流出道重建 先天性心脏缺损 心脏外科手术 

分 类 号：R654.2[医药卫生—外科学]