自体心包及其复合补片在心脏手术中选择性的应用  

Selective application of autologous pericardium and its composite patch to cardiac surgery

作　　者：侯迈[1] 王立清[2] 张红超[1] 徐金星[1] 李令珂[1] 陈元恒[1] 李一粟[1] 

机构地区：[1]空军总医院心脏中心外科,北京100142 [2]北京阜外心血管病医院,北京100037

出　　处：《空军医学杂志》2013年第4期203-205,共3页Medical Journal of Air Force

摘　　要：目的总结不同心脏手术中选择性应用自体心包及其复合补片的经验。方法 159例心脏手术中,对于继发孔房间隔缺损、心内膜垫缺损的原发孔房间隔缺损和黏液瘤切除术后房间隔缺失部位,用自体心包片进行修补。自体心包外衬涤纶片作为复合补片主要用于法洛三联症、法洛四联症的肺动脉、右心室流出道的狭窄、主动脉瓣上狭窄和主动脉瓣环细小等需要加宽成形的手术。结果术后无栓塞、感染性心内膜炎等并发症发生,心房间隔缺损术后无残余漏、也无补片钙化和瘤样改变。术后中远期随访,直接应用自体心包片加宽主动脉瓣环2例,超声心动图和CT显示心包补片部位呈主动脉瘤样扩张,而自体心包外衬涤纶片者主动脉均无瘤样扩张。结论自体心包片可直接用于心房间隔部位缺损的心脏修补手术,对于主动脉、肺动脉、右室流出道狭窄部位的心脏手术,因承受压力较大,建议使用自体心包时外衬涤纶片,以防瘤样变形。Objective We intended to investigate the experience of applying the autologous pericardium and its composite patch selectively to cardiac surgery.Methods Autologous pericardium was used directly to repair atrial septal defect or to reconstruct atrial septum after left atrial myxoma resection.Autologous pericardium with dacron composite patch was mainly used for the reconstruction of right outflow tract such as tetralogy of Fallot,pulmonary stenosis and for enlargement of small aortic root in rheumatic heart disease.Results No embolism, infectious endocarditis,residual shunt,patch calcif lcation and aneurysm deformity occurred after atrial septal defect repair.Aneurysm enlargement happened in 2 cases after only autologous pericardium was used for repairing small aortic root in rheumatic heart disease during mid-term followed-up.Conclusion The autologous pericardium was suitable for repairing atrial septal defect and we suggest that autologous pericardium and its composite patch should be applied to the reconstruction of aorta,pulmonary and right outf low tract stenosis to prevent aneurysm deformity.

关 键 词：自体心包 心脏手术 

分 类 号：R615[医药卫生—外科学]