分期和“一站式”Hybrid手术治疗法洛四联症合并体肺动脉侧支血管形成的疗效比较  

Staging and One-Stop Hybrid Approach for Surgical Treatment of Tetralogy of Fallot with Aorto-pulmonary Collateral Artery

作　　者：郑哲[1] 李守军[1] 胡盛寿[1] 王德[1] 刘志刚[1] 张瑛[1] 徐仲英[2] 胡海波[2] 

机构地区：[1]中国医学科学院北京协和医学院阜外心血管病医院小儿心脏外科中心,北京100037 [2]中国医学科学院北京协和医学院阜外心血管病医院放射科,北京100037

出　　处：《中国胸心血管外科临床杂志》2009年第4期250-253,共4页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家"十一五"科技支撑计划项目(2006BAI01A08)~~

摘　　要：目的重症法洛四联症(TOF)常由于合并体肺动脉侧支血管形成(APCAs)而增加手术矫治及术后恢复的难度,为了提高此类患者的手术效果,评价分期和"一站式"Hybrid手术治疗TOF-APCAs患者的临床疗效。方法2003年1月至2007年12月,30例TOF-APCAs患者在阜外心血管病医院接受介入和Hybrid手术治疗。其中15例患者于TOF根治术前后行APCAs栓塞术治疗(分期Hybrid组),15例采用"一站式"栓塞与根治手术治疗("一站式"Hybrid组);两组患者均在低温体外循环下行常规TOF根治术。结果分期Hybrid组患者主动脉造影发现APCAs19支,对其中15支(78%)侧支血管成功进行栓塞,术中结扎2支,4例术前行体肺侧支栓塞,11例为术后行体肺侧支栓塞;5例出现并发症,其中1例因大量肺渗出致呼吸循环衰竭而死亡,其余患者均痊愈出院。"一站式"Hybrid组患者主动脉造影发现APCAs22支,对其中的18支(82%)侧支血管进行了成功栓塞,术中结扎3支,术后1例出现肺渗出,均痊愈出院。分期Hybrid组的住院时间(中位数37dvs.22d,P=0.011)、住院费用(中位数64101元vs.48021元,P=0.033)、ICU滞留时间(中位数7.0dvs.4.7d,P=0.029)、气管内插管时间(中位数131hvs.19h,P=0.009)明显高于"一站式"Hybrid组;两组患者的体外循环时间(P=0.126)、主动脉阻断时间(P=0.174)差异无统计学意义。结论相对于传统的分期Hybrid手术,"一站式"Hybrid手术可简化TOF-APCAs患者的手术过程,提高手术成功率和降低医疗费用。Objective To improve the operative effects of patients who had tetralogy of Fallot with aortopulmonary collateral arteries （TOF-APCAs） and evaluate the clinical effects of staging and one-stop hybrid approach for TOF-APCAs. Methods From January 2003 to December 2007, thirty patients with TOF-APCAs had undergone combined therapy of APCAs embolization and complete surgical repair. Fifteen patients had APCAs embolization therapy before or after TOF radical operation （staging hybrid group ）; Fifteen had one-stop hybrid treatment（one-stop hybrid group）. Results Angiography revealed that there were 19 APCAs in staging hybrid group, and of which 15 （78 %） were embolized successfully. Five cases had complications and one died from respiratory circulating failure. The rest all recovered and discharged. And 22 APCAs were found in one-stop hybrid group, eighteen （82%） of them were embolized successfully. Only one case had pulmonary effusion. The time of hospitalization（median 37 d vs. 22 d, P=0.011）,ICU staying（median 7.0 d vs. 4.7 d,P=0.029）and endotraeheal intubation（median 131 h vs. 19 h,P=0. 009） was obviously longer, and the hospitalization expenses（median 64 101 yuan vs. 48 021 yuan, P=0. 033） were obviously higher in staging hybrid group than that in one-stop hybrid group.And there was no statistical significance in cardiopulmonary bypass time（P= 0. 126） and aortic clamping time（P= 0. 174） between two groups. Conclusion In comparison with traditional staging hybrid approach, one-stop hybrid approach can simplify the operative process for patients who have TOF-APCAs, improve the operative successful rate and cut down expenses.

关 键 词：栓塞 体肺侧支血管形成 法洛四联症 一站式 杂交 外科 

分 类 号：R726.5[医药卫生—儿科]