右室双出口心室内隧道修补术的优化  

Optimized Surgical Indication and Management of Intraventricular Tunnel Repair of Double-Outlet Right Ventricle

作　　者：王顺民[1] 徐志伟[1] 苏肇伉[1] 丁文祥[1] 

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

出　　处：《上海第二医科大学学报》2005年第2期176-178,190,共4页Acta Universitatis Medicinalis Secondae Shanghai

基　　金：上海市科委基金 (0 0 4 1 1 90 83)资助项目

摘　　要：目的对心室内隧道修补术的适应证和方法提出优化意见。方法 12 0例右室双出口 (DORV)患者接受心室内隧道修补手术 ,采用纵行切开右室流出道 ,用一补片作右心室内隧道 ,连接室间隔缺损与主动脉口 ,引导左心室血在补片下进入主动脉 ,根据解剖情况扩大右室流出道和肺动脉。另有 2例内隧道通过右房切口建立 ;对限制性室间隔缺损 ,同时扩大室间隔缺损直径。结果术后发生低心排 37例 ,总住院死亡为 2 0例 (16 .7% ) ,近 5年死亡 3例 (6 .0 % ) ,其中室间隔缺损远离大动脉开口的DORV病例行心室内隧道修补手术死亡率明显高于室间隔缺损在主动脉下。结论心室内隧道修补术选择受室间隔缺损解剖位置的影响 ,但术前心内探查三尖瓣与肺动脉瓣间距离至关重要 ;通过右房切口建立心内隧道并采用连续缝合的方法 。Objective In order to optimize the surgical indications and managements of double-outlet right ventricle(DORV)repaired with intraventricular tunnel, the case selection, anatomical features, surgical managements and results were reviewed. Methods One hundred and twenty patients with DORV underwent intraventricular tunnel repair (IVR). The intraventricular tunnels were built through-right ventricular incision in most of patients. A patch graft was used to connect the ventricular septal defect(VSD) to the aorta, which the blood stream from the left ventricle to the aorta. The right ventricular outflow tract and pulmonary artery were enlarged in some cases. The intraventricular tunnels were built through the right atrium in 2 patients. Some restrictive VSDs were enlarged during operations. Results Low cardiac output occurred in 37 patients postoperatively. The whole hospital mortality rate was 16.7%. Three patients died in recent 5 years (6.0%). The hospital mortality rate of DORV with non-committed VSD is much higher than that of DORV with subaortic VSD. Conclusion The choice of IVR is dependent on the site of VSD. A longer tricuspid-pulmonary valvular distance than the diameter of the aorta is the key for the choice of IVR. The intraventricular tunnels built through the right atrium with running suture may provide better myocardial protection.

关 键 词：心室 修补术 室间隔缺损 右室双出口 主动脉 右室流出道 修补手术 结论 引导 优化 

分 类 号：R654.2[医药卫生—外科学]