婴幼儿法乐四联症肺组织病理学与一期根治术中右心室流出道重建方法的关系  

Relationship between the Quantitative Structural Study of Lung and the Right Ventricle Outflow Tract Reconstruction in Infants with Tetralogy of Fallot

作　　者：张晓彤[1] 刘迎龙[1] 阮英茆 于存涛[1] 

机构地区：[1]中国医学科学院中国协和医科大学阜外心血管病医院小儿心脏中心 [2]Department of Pathology,Cardiovascular Institute and Fu WaiHospital,CAMS and PUMC,Beijing100037

出　　处：《中国医学科学院学报》2006年第3期402-405,i0013,共5页Acta Academiae Medicinae Sinicae

基　　金："十五"国家科技攻关计划(2002BA709B09)~~

摘　　要：目的分析要幼儿法乐四联症肺细小动脉和肺泡的病理学改变与一期根治术右室流出道重建方法的关系。方法肺病理标本取自16例8—36个月，体重8-16kg，行一期根治手术的法乐四联症（TOF）患儿和5例4-18个月非心、肺源性疾病死亡的对照组婴幼儿。TOF患儿加宽右心室流出道的方法包括瓣环交界切开、跨肺动脉瓣环补片和同种带瓣血管作为外通道连接右心室．肺动脉。术中测量中心肺动脉直径。形态半定量测量肺细小动脉平均中膜厚度百分比（MT％）、平均中膜面积百分比（MS％）、单位面积肺细小动脉数目（APSC）、单位面积肺泡数（MAN）、平均肺泡内衬间隔（MLI）、肺实质占同切片肺总面积比例（PPA％）和单位面积肺泡数／肺细小动脉数（AAR）。结果TOF组的MT％、MS％和APSC降低，MLI和AAR增高，与对照组比较差异有显著性（P均〈0．05）。单纯肺动脉瓣交界切开、跨肺动脉瓣环心包补片、跨肺动脉瓣环同种带单瓣大动脉血管片（包括1例同种带瓣外通道）3种方法的APSC依次降低，与相应的主肺动脉及左、右肺动脉变化一致，APSC与右肺动脉直径呈正相关（r=0．754，P=0．001）。结论要幼儿法乐氏四联征肺血流减少导致肺细小动脉和肺泡发育异常。根据肺门外肺动脉的发育程度选择右室流出道的重建方法可行。Objective To analyse the relationship between the quantitative structural study of lung and right ventricle outflow tract reconstruction in infants with tetralogy of Fallot. Methods Lung biopsies were taken during the operations in 16 infants suffered from tetralogy of Fallot. Autopsy specimens were obtained from 5 infants died of non-cardiovascular diseases as normal control group. All patients underwent one staged repair. The techniques of-right ventricular outflow tract reconstruction included pulmonary valve commissurotomy （n = 3 ）, transanular pericardial patch （ n = 4）, and transannular homologous monocuspid valve patch （ n = 8 ） ; homograft was used in one patient because of the abnormal coronary artery. The diameters of main pulmonary artery （MPA）, left pulmonary artery （LPA）, and right pulmonary artery （RPA） were measured during operation. The tissue was fixed with buffered formalin and routinely impregnated in wax. Sections were stained by hematoxylin-eosin, and Weigert＇s elastic stain counter-stained by van Gieoson＇s method. Seven parameters of the small pulmonary arteries were obtained, including percentage of media thickness （ % MT）, percentage of media section area （ % MS） , numbers of pulmonary small artery per square centimeter （ APSC）, mean alveolar number （MAN） , mean linear intercept （MLI） , proportion of parenchyma area in total area （ % PPA） , and alveolar/ small arterial ratio per unit area （AAR） by a computer-based image processor for quantitative analysis. Results In the TOF group, % MT, % MS, and APSC significantly decreased, while MLI and AAR significantly increased （P 〈 0. 05, compared with the control group）. APSC decreased in turn after separately using three different techniques of right ventricular outflow tract reconstruction （ i. e. pulmonary valve commissurotomy, transannular pericardium patch, and transannular homologous monocuspid valve patch）, which was paralleled with the diameters of MPA, LPA, and RPA. RPA cor

关 键 词：肺动脉 形态半定量分析 法乐四联症 要幼儿 右心室流出道重建 

分 类 号：R54[医药卫生—心血管疾病] R32[医药卫生—内科学]