间接干预法治疗肺血增多型先天性心脏病相关性支气管狭窄  

Surgical treatment of tracheal or bronchial stenosis related to severe congenital heart disease

作　　者：吴向阳[1] 刘浩[1] 朱洁[1] 关新强[1] 韦亚林[1] 张燕春[1] 陈文胜[1] 李彩娥[1] 雷蕾[1] 张燕花[1] 赵启明[1] 

机构地区：[1]兰州大学第二医院心脏外科,兰州730030

出　　处：《中国胸心血管外科临床杂志》2017年第3期196-200,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：甘肃省卫生厅基本科研项目(GSWST2012-02);兰州大学中央高校基本科研业务费专项资金资助(lzujbky-2013-143)

摘　　要：目的探讨重症先天性心脏病合并与之相关的气管或支气管狭窄患者新的外科治疗方法。方法回顾性分析我院2010年6月至2014年6月重症肺血增多型先天性心脏合并气管或支气管狭窄患者行外科治疗31例患者的临床资料,其中男18例、女13例,平均年龄(14.6±4.0)个月,体重(8.8±3.0)kg。结果术前平均住院时间12 d,术中体外循环时间(65.0±21.0)min,主动脉阻断时间(42.0±16.0)min,术后呼吸机应用时间平均(25.0±18.0)h,ICU滞留时间(4.0±1.8)d。所有患者生存,术后9 d复查胸部X线片示心胸比率较术前降低,但差异无统计学意义(P>0.05)。左心室舒张期末前后径较术前缩小(P<0.05),肺动脉压降低(P<0.01),肺动脉血流速度基本正常;术后9 d动脉血管造影(CTA)示:所有患者肺动脉直径均较术前缩小(P<0.01),气管直径恢复正常28例,残留轻度气管狭窄3例,所有术前不张的肺组织重新复张。随访6个月至4(2.5±1.4)年,无死亡,生长发育良好,心脏彩色超声未见异常,CT示所有患者气管狭窄消失。结论对重症先天性心脏病合并气管或支气管狭窄患者,术中采取解除对气管或支气管的压迫因素的外科措施有必要。这种方法外科操作技术简单、术后恢复快、成活率高、费用低、无远期气管再狭窄,预后良好。Objective To explore a new surgical treatment of patients with severe congenital heart disease associated with tracheal or bronchial stenosis. Methods We retrospectively analyzed clinical data of 32 patients with severe pulmonary blood increased congenital heart disease complicated with tracheal or bronchial stenosis in our hospital between June 2010 and June 2014. There were 18 males and 13 females with an average age of 14.6±4.0 months and a weight of 8.8±3.0 kg. Results Average hospital stay was 12 days. Duration of intraoperative cardiopulmonary bypass was 65.0±21.0 min. Duration of aortic interruption was 42.0±16.0 min. Duration of postoperative ventilator was 25.0±18.0 h. ICU retention time was 4.0±1.8 d. All patients were survived. On the 9th day after surgery, the X-ray chest film revealed that the cardio-thoracic ratio was reduced compared with pre-operation but no statistical significance （P〉0.05）. Left ventricular end-diastolic dimension （LVEDD） was decreased （P〈0.05）. Pulmonary artery pressure was lower （P〈0.01）. The velocity of bloodstream in pulmonary artery was approximately normal. The computed tomography angiography （CTA） on the 9th day after surgery revealed that diameter of pulmonary artery in all patients reduced compared with that of pre-operation （P〈0.01）. Tracheal diameter of 28 patients returned to normal level and 3 patients had residual mild tracheal stenosis. All preoperative atelectasis recovered to normal level. All patients recovered completely. When the patients were followed up for 6 months to 4 years, the patients grew healthily and no abnormity occurred. Conclusion For the patients with tracheal or bronchial stenosis related to severe congenital heart disease,it is necessary to adopt surgical procedure to relieve the pressure of trachea or bronchus.The bronchial decompression surgery is a perfect and effective method for the patients with tracheal or bronchial stenosis related to severe congenital heart disease.

关 键 词：心脏缺损 先天性 肺动脉高压 气管/支气管狭窄 外科学 

分 类 号：R726.5[医药卫生—儿科]