体肺侧支血管封堵治疗在肺血减少型先天性心脏病中的临床应用研究  

Clinical study of transcatheter occluding major pulmonary aorta collateral arteries in patients with cyanotic congenital heart diseases

作　　者：吕震宇[1] 金梅[1] 郭保静[1] 王霄芳[1] 肖燕燕[1] 顾燕[1] 

机构地区：[1]首都医科大学附属北京安贞医院-北京市心肺血管疾病研究所小儿心脏科,100029

出　　处：《心肺血管病杂志》2017年第5期353-355,359,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：基金项目:首都临床特色应用研究与成果推广(Z151100004015069)

摘　　要：目的:探讨肺血减少型复杂先天性心脏病体肺侧支介入封堵治疗的意义、操作技术及安全性。方法:回顾性分析58例并发体肺侧支的肺血减少型先天性心脏病的封堵介入治疗。中位年龄36个月(7~288个月),体质量6.9~64kg,平均15.96kg。本组患儿术前均经超声心动图及心脏CT检查确诊,54例术前封堵侧支血管,4例术后封堵侧支血管。结果:全组58例患者体肺侧支血管共115支,其中63支(54.7%)起源于降主动脉(胸主动脉)。对94支血管进行了封堵(82%),释放弹簧圈204枚。每位患者封堵侧支血管1~6支,放置弹簧圈1~14枚。本组10例因肺动脉未达到根治条件未手术,48例行外科根治手术,死亡3例。死亡原因:1例肝、肾衰竭,1例低心排、灌注肺,1例重症感染、多器官衰竭。结论:本组病例提示对肺血减少型复杂先心合并体肺侧支血管,先期采用经皮介入封堵侧支,再行外科治疗,安全、有效,可减少术后并发症的发生,降低手术病死率。Objective：To summarize the clinical therapy experience of interventional therapy for pa- tients with complex and cyanotic congenital heart diseases with major pulmonary aorta collateral arteries and to explore its therapeutic significance, operating skills and safety. Methods： To retrospectively analyze 58 patients with cyanotic CHD with pulmonary aorta collateral arteries. Median age 36month（Tmonth to 288month）, body weight 6. 9 - 64 （ 15.96 ± 11.82 ） kg. All subjects accepted CT diagnosis and 54 patients underwent interven- tional catheterization to close the collateral arteries. In four cases, collateral arteries were found after surgery and closed by catheterization. Results： A total of 115 major pulmonary aorta collateral arteries were obtained in all patients, 63 （54. 7% ） originated from the descending aorta （thoracic aorta）. 94 vessels were occluded （82%） and 204 coils were released. Each patient was an average of 1 to 6 lateral vessel occlusion, placement of coil 1 to 14 pieces. 48 cases of surgical correction surgery, 10 cases of pulmonary artery conditions did not reach the radical conditions were not surgery. 45 patients were cured, four patients died, 1 case of hepatic and renal failure, 1 case of low cardiac output, 1 case of severe infection. Conclusion： Patients with complex and cy- anotic congenital heart diseases who have major pulmonary aorta collateral arteries can undergo interventional and surgical hybrid therapy to manage the collateral arteries. This method is effective, easy and safe, as well as being repeatable, which can reduce complications and decrease mortality.

关 键 词：肺血减少型先天性心脏病 体肺侧支血管 封堵术 

分 类 号：R54[医药卫生—心血管疾病]