肺动脉根部打孔冠状动脉移植法在大动脉转位手术中的应用  

Application of Transposition of Great Arteries Operation by Transplanting Coronary Arteries to Punched Pulmonary Root

作　　者：王峰峰[1] 范太兵[1] 李群[1] 李斌[1] 徐红亮[1] 石磊[1] 杨玉齐[1] 王媛娜[2] 

机构地区：[1]郑州大学第三附属医院河南省小儿先天性心脏病诊疗中心,郑州450000 [2]曲阜师范大学外语系,山东曲阜273165

出　　处：《实用儿科临床杂志》2011年第23期1791-1792,1803,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的研究采用打孔冠状动脉移植手术纠治新生儿完全性大动脉转位伴室间隔缺损(D-TGA/VSD)的临床效果及预后。方法对比分析河南省小儿先天性心脏病诊疗中心2003年6月-2010年12月收治的28例采用动脉调转术治疗的D-TGA/VSD新生儿围术期的临床资料。其中2008年9月以前手术为常规冠状动脉移植法(常规移植组,18例),以后改为打孔冠状动脉移植法(打孔移植组,10例)。手术年龄12 h～28 d[(12.87±8.63)d],体质量2.3～6.0 kg[(3.89±0.78)kg]。手术均在全麻、深低温、低流量体外循环下完成。结果全组死亡4例,病死率为14.28%。其中打孔移植组和常规移植组的病死率分别为10.00%(1/10例)和16.67%(3/18例),两组比较差异无统计学意义。打孔移植组和常规移植组体外循环时间(P=0.011)、主动脉阻断时间(P=0.014)、手术时间(P=0.021)、术后胸引管引流时间(P=0.011)比较差异均有统计学意义,术后插管天数、监护室天数、术后住院天数、出血量、二次止血次数比较差异均无统计学意义。结论术中打孔冠状动脉移植可明显减少手术时间、体外循环时间、主动脉阻断时间及胸引管引流时间,有利于减少其对患儿的伤害,节约手术时间,提高效率。Objective To investigate the clinical results and prognosis of transposition of great arteries for the newborns associated with ventricular septal defect（D-TGA/VSD） by transplanting coronary arteries to the punched pulmonary root. Methods From Jun.2003 to Dec.2010,28 consecutive D-TGA/VSD newborns in Henan Diagnosis Treatment Center of Congenital Heart Disease,aged 12 hours to 28 days [mean（12.87±8.63） days],body weight were 2.3 to 6.0 kg [mean（3.89±0.78） kg].Newborns hospitalized before Sep.2008 were operated in normal ways,while the others by punch graft ways.The operations were performed under general anesthesia and extracorporeal circulation with profound low temperature and low volume blood flow. Results Four newborns died with a hospital mortality rate of 14.28%,among which the punch graft group with a hospital morality rate of 10.00%（1/10 cases）and the non-punch graft group of 16.67%（3/18 cases）.The morality rate was not statistically different between 2 groups.The difference between 2 groups in the following aspects was statistically significant：cardiopulmonary bypass time（P=0.011）,operation time（P=0.014）,aortic block of time（P=0.021）,and chest tube drainage time（P=0.011）,while it showed no statistic differences as to intubation time,ICU time,postoperative hospitalization time,amount of bleeding and twice hemostasis. Conclusions Punch graft coronary arteries in great arteries can cut operation time,cardiopulmonary bypass time,aortic block of time and chest tube drainage time,thus alleviate injury to the newborns and save operation time for higher efficiency.

关 键 词：打孔移植冠状动脉 大动脉转位 室间隔缺损 婴儿 新生 

分 类 号：R654.3[医药卫生—外科学]