儿童复杂先天性心脏病肺动脉环缩术后二期手术时机的探讨  

The Optimal Timing of Second Stage Procedure after Pulmonary Artery Banding in Children with Complex Congenital Heart Defect

作　　者：陈纲[1] 贾兵[1] 陈张根[1] 李炘[1] 叶明[1] 

机构地区：[1]复旦大学附属儿科医院心血管中心,上海200032

出　　处：《临床小儿外科杂志》2008年第2期28-31,共4页Journal of Clinical Pediatric Surgery

基　　金：上海市重点学科建设资助项目;项目编号B116

摘　　要：目的探讨儿童复杂先天性心脏病肺动脉环缩术后最佳二次手术时机,并对二期手术效果进行评价。方法2002年1月至2007年12月,本中心对32例儿童复杂先天性心脏病实施肺动脉环缩术。32例超声心动图估测环缩近远端压差平均为43.7±9.0mm Hg。22例实施二期手术患儿中,男18例,女4例,年龄15.5±21.9个月。二期手术前经皮血氧饱和度为82.7%±9.1%。术前肺动脉压力为19.5±6.5mm Hg。结果二期手术距第1次手术时间平均7.6±10.8个月(10d至40个月)。其中6例行大动脉调转术,8例行双向腔肺分流术,8例行其他双心室修补术。1例围术期死亡,5例发生围术期并发症。术后经皮平均血氧饱和度为92.0%±8.7%(76%～100%)。按二期手术方法分为单心室修补组、完全性大动脉转位组和双心室修补组,2次手术间隔时间分别为3.9±3.6个月、5.7±9.3个月和12.9±14.1个月。结论肺动脉环缩术后二期手术需根据原发病及进行肺动脉环缩的目的选择个体化二期手术方案和时机,以创造最佳手术条件,减轻肺动脉环缩姑息手术带来的并发症。Objective To discuss the optimal timing of second stage procedure after pulmonary artery banding in children with complex congenital heart defect and evaluate the result of the second stage procedure. Methods 32 children with complex congenital heart defect were undergoing pulmonary artery banding procedure in our center from Jan 2002 to Dec 2007. The pressure gradient trans-banding belt was （43.7 ± 9.0） mmHg examined by echocardiography. 22 cases underwent the second stage procedure. There were 18 boys and 4 girls, the mean age was （15.5 ± 21.9） m, and the mean saturation was （82.7 ± 9.1） %. The mean pulmonary artery pressure was （19.5 ± 6.5） mmHg before the second stage procedure. Results The second stage procedure was 10 d to 40 m away from the pulmonary artery banding procedure, and the mean interval was （7.6 ± 10.8） m. The second stage procedures included 6 cases of arterial switch procedure, 8 cases of bidirectional Glenn procedure, 3 cases of double outlet of right ventricle repair, 2 cases of complete atrioventricular canal repair, 1 case of septation of single ventricle and 2 cases of transthoracic device closure of muscular VSD. There was 1 postoperative death and the morbidity was 5/21. The postoperative saturation was 76 - 100 %. According to the different second stage procedures, the 22 cases were divided into the univentricle repair group, the d-TGA group and the hi-ventricle repair group. The interval time between two surgery stages in 3 groups were （3.9 ± 3.6） m, （5.7 ± 9.3） m and（12.9 ± 14.1） m. Conclusions The kind of second stage procedure of pulmonary artery banding is based on the different kinds of congenital heart defect and the purpose of the banding procedure. Both the second stage procedure and optimal timing of the surgery should be individualized. The appropriate surgery timing can create the better surgery conditions and reduce the opportunity of complications induced by the pulmonary artery banding procedure.

关 键 词：先天性心脏病 肺动脉环缩术 心脏缺损 症状 儿童 

分 类 号：R726.5[医药卫生—儿科]