Nikaidoh术治疗完全型大动脉错位伴室间隔缺损和肺动脉狭窄的早期结果  

Application of Nikaidoh Operation to the Treatment of Transposition of Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis

作　　者：徐志伟[1] 刘锦纷[1] 严勤[1] 史珍英[1] 朱德明[1] 丁文祥[1] 苏肇伉[1] 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心心胸外科,上海200127

出　　处：《中国胸心血管外科临床杂志》2007年第3期161-164,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：上海市科委自然科学基金重点项目(044119627)~~

摘　　要：目的回顾性研究Nikaidoh术治疗完全型大动脉错位伴室间隔缺损和肺动脉狭窄(TGA/VSD/PS)的早期结果。方法在2004年1月至2005年12月期间,有8例TGA/VSD/PS患者在我院接受Nikaidoh术矫治,手术年龄4～29个月(11.4±7.6个月),体重5.2～11.0kg(8.0±1.9kg);所有患者房室连接一致,其中伴房室瓣骑跨1例,左肺动脉狭窄1例,本组患者术前均未行其他手术,手术均采用改良Nikaidoh术,即主动脉根部移位和重建左、右心室流出道,除1例冠状动脉同时移植和使用Homograft重建右心室流出道外,用自体心包补片扩大重建右心室流出道。结果手术死亡1例,无1例出现明显左室流出道梗阻(LVOTO)和右室流出道梗阻(RVOTO),轻度肺动脉反流3例,中度4例,除1例死亡患者外,其余左心功能均正常;随访时间平均8.8个月(3～18个月),7例存活;心功能状况佳,射血分数(EF)0.64±0.02;短轴缩短率(FS)0.33±0.02。未出现进展性主动脉瓣反流、LVOTO、RVOTO和肺动脉反流加重。结论Nikaidoh术适宜于治疗TGA/VSD/PS,尤其当解剖上存在不宜行Rastelli术的患者,早期结果良好。Objective To review the short-term outcome of modified Nikaidoh operation, aortic translocation and biventricular outflow tract reconstruction as an alternative surgical procedure for the treatment of transposition of the great arteries with ventricular septal defect and pulmonary stenosis （TGA/VSD/PS）. Methods Between January 2004 and December 2005, 8 consecutive patients had undergone Nikaidoh procedure for the treatment of TGA/VSD/PS at Shanghai Children＇s Medical Center. All patients had ventriculoarterial discordance and atrioventricular concordance. Associated lesions included a straddling atrioventricular valve in one patient and hypoplastic left pulmonary artery. The median age at operation was 11.4±7.6months （4 to 29months）. Weight of body was 8.0± 1. 9kg （5.2 to 11.0kg）. No patient had previous palliative procedure. The surgical technique used was a modification of the Nikaidoh procedure. Results The median total cardiopulmonary bypass time was 176± 50 minutes （range, 112 to 250 minutes）, and the median aortic cross-clamp time was 101± 27 minutes （range, 73 to 139minutes）. The median length of stay in the intensive care unit was 12 ± 9 days, with a median hospital stay of 19± 12 days. There was 1 hospital death as a result of severe left ventricle failure. There was no residual left ventricular outflow tract obstruction （LVOTO） and right ventricular outflow tract obstruction （RVOTO）, but 3 patients with mild to moderate pulmonary regurgitation and 4 patients with moderate. At a median follow-up of 8.8 months （range, 3 to 18months）, all patients were alive. All have the normal ventricular function. There were ejection fraction （EF） 0.64±0.02 and fractional shortening （FS） 0. 33±0. 02. None of the patients developed aortic insufficiency and progressed LVOTO or RVOTO. Conclusions Nikaidoh procedure is a valuable surgical option for TGA/VSD/PS in infant, especially in the presence of ＂inadequate anatomy＂ for a Rastelli repair. Big evidence and longer fol

关 键 词：完全型大动脉错位 室间隔缺损 肺动脉狭窄 RASTELLI术 Nikaidoh术 

分 类 号：R654.2[医药卫生—外科学]