先天性冠状动脉瘘的诊断与外科治疗（附11例报告）  

Research on diagnosis and surgical treatment of congenital coronary artery fistula

作　　者：李春生[1] 严中亚[1] 卢中[1] 朱正艳[1] 雷宏[1] 孙云[1] 程光存[1] 

机构地区：[1]安徽医科大学附属省立医院心脏外科,合肥230001

出　　处：《中国医师进修杂志》2016年第3期217-220,共4页Chinese Journal of Postgraduates of Medicine

基　　金：安徽省科技攻关项目（13010142198）

摘　　要：目的总结分析先天性冠状动脉瘘（CCAF）的临床诊断和外科手术方法。方法回顾性分析经超声心动图、CT造影、冠状动脉造影检查确诊的11例CCAF患者的临床资料，其中4例为单纯性CCAF，7例合并其他心内畸形。5例采用非体外循环手术，其中1例行冠状动脉下切线褥式缝合，4例行瘘支动脉结扎术。6例在体外循环下修补瘘口，其中3例合并右冠状动脉瘤患者切开冠状动脉，瘘口带垫片Prolene线间断缝合修补瘘口；3例切开右心房，心腔内修补瘘口。结果所有患者均成功完成外科手术治疗，无一例死亡，超声心动图复查均无残余瘘存在。10例患者随访3个月至5年，无死亡及并发症发生。结论联合应用超声心动图、CT血管造影及冠状动脉造影检查可极大地提高了诊断准确率，同时为手术方案的制定提供更直观的依据。CCAF明确诊断后，行外科手术治疗安全可靠。合并冠状动脉瘤患者应尽量保留扩张的冠状动脉，术后加强抗凝治疗防止血栓形成。Objective To summarize and analyze clinical diagnosis and surgical treatment methods of 11 cases with congenital coronary arterial fistula （CCAF）. Methods The clinical data of 11 patients who were definited by ultrasonic cardiogram, CT angiography （CTA） and coronary angiography were analyzed retrospectively. Four cases were simple CCAF, 7 cases coexisted with other heart abnormalities. Six cases were given surgical closure of fistula without cardiopulmonary bypass. One of the cases adopted coronary artery under the tangent cotton-padded mattress suture, and 4 cases fistula arterial were ligatured directly. Six cases were given surgical closure of fistula under cardiopulmonary bypass. The right coronary arterial was opened in three of the cases with right coronary artery aneurysm to close fistula. The chambers of heart in the others were opened to close fistula. Results All patients received surgical treatment successfully, and no death happened during the operation. The ultrasonic cardiography showed that all patients recovered well. Follow-up was conducted on 10 patients with the time period ranging from 3 months to 5 years. There was no death and no complication. Conclusions Combined application of ultrasonic cardiogram, coronary angiography and CTA increases the accuracy rate of diagnosis greatly and otters visual bases to formulate operation plan. Surgical operation is quite effective for congenital coronary arterial fistula after definite diagnosis. Operator should try to reserve the expanded coronary arterial, strengthen the anticoagulant after opeation to prevent thrombosis.

关 键 词：冠状动脉瘤 诊断 冠状动脉瘘 

分 类 号：R654.2[医药卫生—外科学]