镶嵌技术治疗短段型主动脉缩窄合并室间隔缺损的中期随访研究  

Hybrid technique for treatment of short-segment coarctation associated with ventricular septal defect

作　　者：张惠锋[1] 叶明[1] 陈纲[1] 刘芳[1] 吴琳[1] 贾兵[1] 

机构地区：[1]复旦大学附属儿科医院心胸外科,上海201102

出　　处：《中华小儿外科杂志》2015年第8期570-573,共4页Chinese Journal of Pediatric Surgery

摘　　要：目的对于心导管球囊扩张主动脉缩窄结合心脏直视下修补室间隔缺损来纠治部分小婴儿主动脉缩窄合并室间隔缺损的应用，仍存在着较大争议；本研究将该镶嵌技术应用于短段型主动脉缩窄合并室间隔缺损的一期纠治中，并通过中期随访，分析该镶嵌技术的应用效果，明确其应用前景。方法回顾性研究2009年1月至2013年6月期间，应用镶嵌技术治疗主动脉缩窄合并室间隔缺损的小婴儿32例，均不伴有粗大的动脉导管未闭；其中男24例，女8例，年龄15～190d，平均（58．2±43．1）d，体质量1．9～7坛，平均（3．9±1．3）kg；29例患儿于心导管室介入球囊抗张主动脉缩窄，3例于手术室心脏直视下自主动脉弓置入球囊扩张，选择球囊大小为4～8mm，平均（5．7±1．0）mm，扩张后主动脉缩窄段内径从术前（2．0±0．6）mm增大至术后（3．8±0．8）mm，压差从术前（31．7±12．4）mmHg（1mmHg：0．133kPa）下降至（7．3±5．1）mmHg。全组病例于球囊扩张后在体外循环下完成室间隔缺损修补手术，体外循环时间32-87min，平均（49．8±14．9）min，主动脉阻断时间18-41min，平均（25．6±8．2）min。结果全组病例均得到成功纠治，无手术死亡，随访10～63个月，无晚期死亡，心功能恢复至NYHAI级。术后应用心脏超声常规随访，未发现室间隔缺损残余分流，未发现主动脉假性动脉瘤；1年免于主动脉弓再狭窄率84．4％，5年84．4％，1年免于再干预率90．6％，5年87．5％，其中3例进行了球囊的再次扩张，1例采用左胸外侧切口，在非体外循环下进行狭窄段切除，主动脉端端吻合，术后随访均无再狭窄发生。结论镶嵌手术在部分短段型主动脉弓缩窄伴有室间隔缺损的纠治中取得了良好的效果，中期随访主动脉再狭窄率低，并且多可通过球囊再次扩张得到完全纠治。Objective To assess the advantages and outcomes of hybrid technique for repairing coarctation （CoA）, ventricular septal defect （VSD） through mid-term follow-ups. Methods A total of 32 selected patients with short-segment CoA/VSD without obvious patent ductus arteriosus （PDA） underwent one-stage complete repair with hybrid technique from January 2009 to June 2013. There were 24 boys and 8 girls with a mean age of （58. 2± 43.1）（15-190） days and a mean weight of （3. 9 ±0. 3）（1.9-7） kg. Twenty-nine patients underwent balloon dilatation in catherization laboratory while the remainder in operation room. The mean balloon size was 4-8 （5.7± 1.0） ram. The mean diameter of coarctation increased from （2. 0 ± 0. 6） to （3.8 gradient pressure declined from （31.7 ± 12. 4） to ±0. 8） mm immediately after dilatation while the （7. 3 ± 5.1） mmHg. Then all patients underwent open heart surgery with a mean duration of eardiopulmonary bypass at （49. 8 ± 14. 9） （32-87） min and a mean duration of aortic clamp at （25.6 ± 8. 2） （18-41） rain. Results The above hybrid technique was all successful without intraoperative mortality. There was no late mortality during a follow-up period of 1-63 months. Neither residual VSD nor pseudoaneurysm occurred. At 1 and 5 years post-operation, the freedom rates from aortic re-stenosis were 84. 4% and 84. 4% and the freedom rates from re- intervention 90. 6% and 87. 5% respectively. Three patients received re-balloon dilatation at 8, 12 and 13 months post-operation. Only there was one case of end-to-end anastomosis through left thoracotomy. And none had re-stenosis. Conclusions Hybrid technique has excellent outcomes in thetreatment of sbort-segment CoA/VSD. And its incidence of aortic re-stenosis and re-intervention is acceptable during mid-term follow-ups. Furthermore, most cases of aortic re-stenosis may be successfully relieved by re-balloon dilatation.

关 键 词：主动脉缩窄 室间隔缺损 心脏外科手术 气囊扩张术 

分 类 号：R726.5[医药卫生—儿科]