肺动脉瓣窦扩大在婴幼儿法洛四联症保留肺动脉瓣纠治术中的应用研究  

Applied research of pulmonary valve sinus expansion in pulmonary valve-sparing of infantile tetralogy of Fallot

作　　者：谢学良[1] 明腾[1] 邹勇[1] 黄国金[1] 

机构地区：[1]江西省儿童医院小儿心脏病治疗中心,江西省南昌市330006

出　　处：《临床小儿外科杂志》2017年第5期469-472,共4页Journal of Clinical Pediatric Surgery

摘　　要：目的探讨肺动脉瓣窦扩大技术在婴幼儿法洛四联症保留肺动脉瓣根治术中的意义。方法 2013年1月至2016年6月,本院共收治272例肺动脉瓣环发育差(Z值<-2)的法洛四联症患儿,回顾性分析相关临床资料;其中35例行肺动脉瓣窦扩大术(Ⅰ组),237例行传统跨肺动脉瓣环补片纠治术(Ⅱ组),对比两组围手术期资料,分析肺动脉瓣窦扩大技术在婴幼儿法洛四联症保留肺动脉瓣根治术中的早、中期治疗效果。结果术后早期(术后30 d内)死亡5例(病死率1.84%),均为传统跨肺动脉瓣纠治患儿(Ⅱ组),死亡原因均为术后严重低心排出量综合征。35例行肺动脉瓣窦扩大患儿术前测得肺动脉瓣环Z值为-2^-4,术中外循环时间48~92 min,平均(68.2±23.5)min,主动脉阻断时间39~71 min,平均(51.8±19.1)min,术后新肺动脉瓣环Z值0.5^-1,右室/左室压力比(PRV/PLV)0.40~0.71,平均为(0.52±0.19),右室流出道-肺动脉压力阶差13~31 mmHg,平均为(19.15±10.87)mmHg,与Ⅱ组比较差异无统计学意义(P>0.05)。而Ⅰ组术后肺动脉反流程度均为轻度及轻度以下,术后呼吸机辅助呼吸时间为15~57 h(42.6±18.2 h),术后住院时间为6~12 d(12.9±5.7 d),与Ⅱ组比较差异有统计学意义(P<0.05)。结论婴幼儿TOF根治术中,使用肺动脉瓣窦扩大技术可以有效减轻肺动脉瓣反流,提高肺动脉瓣保留比例,并有利于患儿临床恢复。Objective To explore the role of pulmonary valve sinus expansion in pulmonary valve-sparing of infantile tetralogy of Fallot（ TOF）. Methods Retrospective analyses were performed for the clinical data of 272 TOF cases（ pulmonary valve ring Z-value -2） from January 2013 to June 2016. Pulmonary valve sinus expansion（ group I,n = 35） and conventional trans-pulmonary valve ring patch correction（ groupⅡ,n = 237） were performed. The perioperative data of two groups were analyzed to determine the early and middle effects of pulmonary valve sinus expansion in infantile TOF with pulmonary valve-sparing. Results Five patients died within 30 days post-operation with a mortality rate of 1. 84%. All of them belonged to groupⅡ. The mortality cause was severe postoperative low-cardiac-output syndrome. Thirty-five cases underwent pulmonary valve sinus expansion. Preoperative Z-value of pulmonary valve ring was-2 to-4,CPB time（ 68. 2 ± 23. 5）（ 48-92） min,aortic clamping time（ 51. 8 ± 19. 1）（ 39-71） min,Z-value of postoperative pulmonary valve ring 0. 5 to-1,right ventricular/left ventricular pressure ratio（ PRV/PLV）（ 0. 52 ± 0. 19）（ 0. 40-0. 71） and pressure gradient of right ventricular outflow tract to pulmonary artery（ 19. 15 ± 10. 87）（ 13-31） mmHg. There was no significant inter-group difference. In group I,the degree of pulmonary regurgitation was mild or less. And the duration of postoperative ventilation was（ 42. 6 ± 18. 2）（ 15-57） and postoperative hospital stay（ 12. 9 ± 5. 7）（ 6-12） days. Compared with group Ⅱ,there were significant differences. Conclusion Pulmonary valve sinus expansion of infantile TOF can effectively reduce pulmonary regurgitation,improve valve-preserving ratio and accelerate postoperative recovery.

关 键 词：心脏病/先天性 法洛四联症 外科手术 肺动脉瓣 

分 类 号：R726.5[医药卫生—儿科]