超低温保存同种异体带瓣管道在肺动脉闭锁手术中的应用  

Application of cryopreserved valved homograft conduit in the treatment of pulmonary atresia

作　　者：潘广玉[1] 吴清玉[2] 唐秀杰[2] 靳永强[2] 

机构地区：[1]北京大学国际医院心血管外科,北京102206 [2]清华大学附属第一医院心脏中心,北京100016

出　　处：《基础医学与临床》2015年第12期1659-1662,共4页Basic and Clinical Medicine

摘　　要：目的观察同种异体带瓣管道（同种异体带瓣主动脉或肺动脉）应用于肺动脉闭锁根治手术中的治疗效果。方法2005年10月至2014年5月，清华大学附属第一医院在17例肺动脉闭锁合并室间隔缺损的手术中用超低温保存的同种异体带瓣管道重建右室流出道。所有病例均为肺动脉闭锁合并室间隔缺损。主动脉肺动脉分流术后7例，肺动脉单源化手术后3例，距离第1次手术平均时问为2．1年。男性患者10例，女性患者7例。年龄1～16岁，平均6．4岁。体质量8～50kg，平均21．6kg。同种带瓣肺动脉管道14例，同种带瓣主动脉管道3例，管道直径20～24mm，平均22．1mm。结果术后低心排出量死亡1例，其余16例出院，1例因出现完全房室传导阻滞于术后1个月植入永久起搏器。随访6个月到8．5年，平均为4．5年。随访的16例中，中度肺动脉瓣反流1例，中度三尖瓣反流3例，轻度肺动脉瓣狭窄2例。15例未见明显肺动脉瓣反流。2例分别于第5、7年出现肺动脉跨瓣压差64、58mmHg。带瓣管道完好率为68．8％，无随访死亡病例。结论作为右室流出道重建材料，同种异体带瓣管道应用于肺动脉闭锁矫治手术能取得良好的疗效。Objective To observe theraputic value the outcomes of the treatment of pulmomary atresia treat- ment with ventricle septum defect utilizing the cryopreserved valved homograft conduits in pulmonary atresia patients. Methods Cryopreserved valved homograft conduits were implanted from October 2005 to May 2014 from 17 patients of pulmonary atresia with ventricle septum defect. Cryopreserved pulmonary homograft con- duits were implanted in 11 patients, and aortic homograft conduits were implanted in 3 patients. Average con- duit size was 22. 1 ram. Routine electrocardiogram, transthoracic echocardiography and chest radiography was performed to assess the degree of pulmonary insufficiency and stenosis at 3 months, and then every 6 - 12 months postoperatively. Results The patient of early death is a 1-year girl, 8 kg with pulmonary atresia caused by ventricle septum defect, patent ductus ateriosus, patent foramen ovale. Left ventricle is dysplasia and there is narrow at the beginning of left pulmonary atery. One patient had to be implanted a permanent pacemaker because of complete atrioventricular heart block 30 days after operation. Sixteen cases discharged. The mean follow-up peri- od was 4.5 years （range, 6 months to 8.5 years）. During the follow-up, echocardiography showed moderate pul- monary valvular regurgitation in 1 patient and moderate tricuspid valvular regurgitation in 2 patients. Fifteen pa- tients did not show obvious pulmonary insufficiency. Gradient pressure of pulmonary vavle was 64mmHg and 58 mmHg at the 5th and 7th year after operation respectively in two patients. Conclusions Cryopreserved valved homograft conduit may provide a reliable option for reconstruction of right ventricle outflow tract in patients with pul-monary atresia.

关 键 词：先天性 肺动脉闭锁 同种 移植 

分 类 号：R654.2[医药卫生—外科学]