儿童右室双出口的外科治疗  

Surgical correction of double outlets of the right ventricle in children

作　　者：莫绪明[1] 谷兴琳[1] 钱龙宝[1] 张儒舫[1] 顾海涛[1] 夏建海[1] 

机构地区：[1]南京医科大学附属南京儿童医院心胸外科,210008

出　　处：《江苏医药》2005年第2期96-98,共3页Jiangsu Medical Journal

基　　金：江苏省医学重点人才基金及江苏省社会发展项目基金(BS2002306)

摘　　要：目的探讨小儿右室双出口(DORV)的外科治疗体会.方法 DORV病儿63例,年龄2个月～13岁,平均(4.25±3.46)岁,体重5～44 kg,平均(14.3±7.46) kg.室间隔缺损(VSD)位于主动脉瓣下44例,肺动脉瓣下4例,靠近主、肺动脉开口14例,远离主、肺动脉开口1例.肺动脉高压(PH)19例,肺动脉狭窄(PS)41例和肺动脉闭锁(PA)3例.合并双VSD 3例,房间隔缺损10例,冠状动脉畸形4例,左肺动脉狭窄3例,二尖瓣病变3例,动脉导管未闭6例,无脾综合征1例,主动脉弓缩窄2例,右位心3例,左心发育不良4例,无顶冠状窦1例,室壁瘤/胸腹壁缺损1例.结果一期根治手术51例,分期手术12例.手术死亡6例,病死率9.52%.随访1个月～12年,2例有轻度流出道残余梗阻,2例VSD残余漏,其中1例死亡,余生存良好,仍在随访中.结论认清病理解剖关系,采取合适的手术方法,尽量在幼儿期行根治手术,加强术后监护,是取得DORV良好治疗效果的保证.Objective To review the clinical experience of surgical correction of double outlets of right ventricle in 63 children.Methods 63 patients with age of 2 months～13 [mean(4.25±3.46)] years and body weight of 5～44[mean(14.3±7.46)]kg underwent surgical repair for DORV.There were 44 cases of subaortic VSD,4 subpulmonary VSD,14 doubly committed VSD and 1 noncommitted VSD.19 cases were associated with pulmonary hypertension,41 pulmonary stenosis and 3 pulmonary atresia.Associated cardiac abnormalities included double VSDs in 3 cases,atrial septal defect in 10,left pulmonary stenosis in 3,patent ductus arteriosus in 6,aortic coarctation in 2,and asplenia syndrome in 1.All patients underwent surgical treatment.Results Total repair was performed in 51 cases and the palliative operation in 12.There were 6 cases of total hospital death.The mortality rate was 9.52%.The patients had been followed up from 1 month to 12 years.There was 1 case of late death.The rest remained well.Conclusion Understanding DORV pathologic anatomy thoroughly,selecting suitable surgical management,undergoing surgical treatment in early life,and making proper postoperative care are important factors influencing on surgical outcome of DORV in children.

关 键 词：右室双出口 VSD 外科治疗 肺动脉狭窄 随访 二尖瓣病变 肺动脉瓣 PA PS PH 

分 类 号：R654.2[医药卫生—外科学] R541[医药卫生—临床医学]