两种不同手术方式矫治完全性大动脉错位伴有室缺和肺动脉狭窄的效果分析  

Analysis of outcome of application Nikaidoh or Rastelli procedure to repair transposition of the great arteries with ventricular septal defect and pulmonary stenosis

作　　者：严勤[1] 徐志伟[1] 刘锦纷[1] 杜欣为[1] 史珍英[1] 朱德明[1] 苏肇伉[1] 丁文祥[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,200127

出　　处：《临床外科杂志》2010年第12期840-843,共4页Journal of Clinical Surgery

基　　金：基金项目：上海市科学技术委员会重大项目基金（044119627）

摘　　要：目的 回顾性分析两种不同手术方式矫治完全性大动脉错位（TGA）伴有室间隔缺损（VSD）和肺动脉狭窄（PS）的效果.方法 对46例TGA/VSD/PS的患者进行手术矫治,其中采用主动脉根部移位/重建双室流出道术,即Nikaidoh术27例（N组）,Rastelli手术19例（R组）.N组采用自身心包补片重建右室流出道（RVOT）,其中1例用同种异体带瓣管道Homograft;R组使用Homograft重建RVOT.两组均无手术前姑息手术史.结果 N组因术后严重心功能衰竭死亡1例（3.7%）,R组无死亡.术后早期并发症的发生率两组相近.手术平均年龄N组（16.3±16）个月,R组（51±20）个月,N组明显小于R组（P=0.028）.N组术后无明显残余左、右心室流出道梗阻（LVOTO、RVOTO）,而R组有37%患者分别存在LVOTO或RVOTO（P＜0.05）,但N组术后89%患者存在轻-中度肺动脉血反流现象,R组仅1例患者存在轻度反流（P＜0.05）,两组手术早期心功能状况差异无统计学意义;随访期两组均无死亡,但R组有4例（23.6%）因LVOTO、RVOTO再手术治疗.结论 Nikaidoh术矫治TGA/VSD/PS患者,在解剖上更胜一筹,适宜于小的年龄患者.Objective To analyse the early results of the management of transposition of the great arteries with ventricular septal defect and pulmonary stenosis by Nikaidoh procedure or Rastelli procedure. Methods From January 2000 to June 2009,46 patients had underwent Nikaidoh＇s or Rastelli＇s procedure for the management of Transposition of the Great Arteries with Ventricular Septal Defect and Pulmonary Stenosis （TGA/VSD/PS） in our Center. In group N （ Nikaidoh＇s ） , the reconstruction of right ventrieular outflow tract（RVOT） by autograft of pericardium patch on 26 patients, and one patient with homograft of pericardium patch. In group R （ Rastelli＇s ） , the reconstruction of RVOT was made by homogrft on 19 patients who is with a median age of 4 years old. All patients of both had not previous palliative procedure. Results There were one death result from severe heart failure in group N, no death in group R in the Hospital. The morbidity was similar between the tow groups in the early postoperative complications. The postoperative Echo examination showed no residual RVOTO or LVOTO and 89% patients with mild to moderate pulmonary insufficiency（PI） in group N, but there were 37% cases with RVOTO or LVOTO and only one with mild PI in group R（ P 〈 0.05 ）. There was no significance difference in the heart function between the two groups, but lower surgical age in - group A. During follow - up, there were re - operation in four cases with LVOTO/RVOTO progressively in group R. Conclusion The two procedures are both valuable surgical option for the management of TGA/VSD/PS. But Nikaidoh procedure is suitable for younger patients and results in a more anatomically correct alignment between the ventricle and great artery.

关 键 词：完全性大动脉错位伴室间隔缺损和肺动脉狭窄 RASTELLI术 Nikaidoh术 

分 类 号：R655[医药卫生—外科学]