手术联合介入栓堵大体肺动脉侧支治疗肺血减少型先天性心脏病的手术疗效分析（附151例报告）  

Operation-effect analysis of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries

作　　者：刘迎龙[1] 闫军[1] 张戈军[2] 沈向东[1] 王旭[3] 吕小东[1] 罗国华[1] 李晓锋[1] 王栋[1] 凌锋[1] 刘爱军[1] 

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 [3]中国医学科学院北京协和医学院阜外心血管病医院PICU,北京100037

出　　处：《中华胸心血管外科杂志》2010年第5期313-316,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受北京自然科学基金资助（7072049）

摘　　要：目的 比较外科手术联合术前、术中（包括栓堵当日手术及同期Hybrid手术）及术后介入栓堵治疗合并大体肺动脉侧支（MAPCAs）肺血减少型先天性心脏病的手术疗效,探讨联合术式的时机.方法 1992年至2009年11月手术联合栓堵共151例,成功栓堵MAPCAs 252支.其中1992年至2007年7月28例,包括手术前栓堵3例（10.7%）、栓堵当日手术19例（67.9%）、术后栓堵6例（21.4%） 2007年7月成立Hybrid手术室后行间期Hybrid手术115例（93.5%）、术前栓堵3例（2.4%）、术后栓堵5例（4.1%）.一期矫治132例,姑息手术19例,其中7例再行二期矫治.结果 全组手术死亡11例（7.3%）,其中成立Hybrid手术室后死亡5例（4.1%）明显低于2007年7月前的6例（21.4%）,同期Hybrid手术死亡也由21.1%（4/19例）降至4.3%（5/115例）.术前栓堵6例均无死亡,术后栓堵死亡2例均为2007年7月前死亡.术前、术中栓堵呼吸机使用时间、ICU住院时间、术后住院时间及住院费用均显著低于术后栓堵者（P=0.000、0.000、0.000）.成立Hybrid手术室后病人住ICU时间及术后住院时间均显著低于2007年7月前（P=0.002及0.002） 同期Hybrid手术的ICU住院时间由2007年7月前的8.38天缩短至5.37天（P=0.079）,术后住院时间由18.74天减少至13.01天（P=0.059）.结论 成立Hybrid手术室后同期Hybrid手术死亡显著下降,病人住ICU时间及术后住院时间缩短,手术疗效改善.术前、术中栓堵伴MAPCAs的肺血减少型先天性心脏病较术后栓堵者使用呼吸机、ICU及术后住院时间缩短,住院费用降低.术后栓堵作为补救措施可减少相关并发症的发生,是治疗MAPCAs的有益补充.Objective To evaluate the operation-effect of surgical repair combined with collateral embolization for cyanotic congenital heart disease with major aortopulmonary collateral arteries （MAPCAs） and optimal time of the associated operation. Methods We retrospectively reviewed the clinical data of 151 patients with cyanotic congenital heart disease and MAPCAs from 1992 to Nov of 2009. Two hundred and fifty two MAPCAs were embolized. One hundred and thirty two patients were performed one-stage surgical correction, another 19 patients received palliative operation and 7 patients received staging surgical repair after palliative operation. Results All patients received combined therapy of MAPCAs embolization and surgical repair with total in-hospital mortality of 7.3%. There was no death in 6 cases of preoperative interventional embolization, 2 death in 6 cases of postoperative embolization before July 2007 and none after July 2007. Simultaneous hybrid procedures （4.3%） had lower in-hospital mortality than intraoperative embolization before July 2007 （21.1%）. There were significant differences regarding the duration of respirator usage, duration of ICU and postoperative hospital stay, as well as the cost of hospitalization for the preoperative, intraoperative and postoperative embolization groups （ P = 0.000, 0.000 and 0.000, respectively）. Patients had a shorter duration of ICU and hospital stay after July 2007 （ P = 0.002, 0.002 ）. The duration of ICU and hospital stay in simultaneous hybrid procedures was shorter than those of intraoperative embolization before July 2007 （5.37 days vs. 8.38 days, P=0.079 and 13.01 days vs. 18.74 days, P=0.059, respectively）. Conclusion The surgical volume of the associated opertaion increased rapidly since the establishment of hybrid operating room. Simultaneous hybrid surgery significantly reduced the operative mortality, shortened the duration of ICU and hospital stay, and improved the operation-effect. Preoperative and intraoperative embolization could all

关 键 词：心脏缺损 先天性 侧支循环 Hybrid手术 介入栓堵 

分 类 号：R686[医药卫生—骨科学]