不同姑息性手术对肺动脉闭锁合并室间隔缺损患者肺血管发育促进作用的比较  

Impact of Right Ventricle to Pulmonary Artery Connection or Systemic-to-Pulmonary Artery Shunt Surgery on Promoting the Development of Pulmonary Vasculature in Patients With Pulmonary Atresia and Ventricular Septal Defect

作　　者：张永辉[1] 花中东[1] 王旭[1] 闫军[1] 王强[1] 李守军[1] 马凯[1] ZHANG Yong-hui;HUA Zhong-dong;WANG Xu;YAN Jun;WANG Qiang;LI Shou-jun;MA kai(Department of Pediatric Cardiac Surgery,National Center for Cardiovascular Diseases and Fuwai Hospital,CAMS and PUMC,Beijing（100037）,China)

机构地区：[1]中国医学科学院北京协和医学院国家心血管病中心阜外医院小儿心脏外科中心,北京市100037

出　　处：《中国循环杂志》2018年第11期1108-1112,共5页Chinese Circulation Journal

基　　金：国家重点研发计划资助项目(2017YFC1308100)

摘　　要：目的:比较体肺分流术和姑息性右心室肺动脉(RV-PA)连接术两种不同姑息手术方式在肺动脉闭锁室间隔缺损患者分期矫治中的治疗效果。方法:回顾性分析2009-12至2012-08连续在我院行分期手术治疗的92例合并肺动脉发育不良的肺动脉闭锁室间隔缺损患者,以比较行体肺分流术(n=47)和姑息性RV-PA连接术(n=45)患者的围手术期结果、术后肺血管发育情况以及最终根治率等的差异。结果:平均随访(2.01±1.02)年时,两组肺血管发育指标Nakata指数、McGoon比值均较术前明显升高(P均<0.001),但两组间差异未见统计学意义(P均> 0.05)。姑息性RV-PA连接术组最终获得解剖学根治的比例明显高于体肺分流术组(62.2%vs 31.9%,P<0.01)。根治手术时姑息性RV-PA连接术组紫绀情况较体肺分流术组改善明显,手术时间也明显减少(P均<0.001);重症监护病房滞留时间和呼吸机使用时间虽有缩短但未见统计学差异。结论:相较于体肺分流术,姑息性RV-PA连接术作为促进肺动脉闭锁室间隔缺损分期手术的姑息手术,能更有效地提高根治率,可能有利于二次根治手术时患者恢复。Objectives： To compare the effect between the right ventricle to pulmonary artery connection and the systemic-topulmonary artery shunt palliative surgery in patients with pulmonary atresia and ventricular septal defect.Methods： A total of 92 consecutive patients（mean age [1.69 ± 1.72] years, range 0.2-8.1 years） diagnosed with pulmonary atresia, ventricular septal defect and pulmonary artery hypoplasia（Nakata index [87.51 ± 36.97] mm^2/m^2; McGoon ratio 0.97±0.28） from December 2009 to August 2012 in our hospital were included in this retrospective study. 45 patients underwent the procedure of right ventricle to pulmonary artery connection（RV-PA） and 47 underwent the systemic-topulmonary artery shunt surgery, some patients also received simultaneous transcatheter occlusion of major aortopulmonary collaterals and/or pulmonary angioplasty. The mechanical ventilation time and ICU monitoring time, the pulmonary vascular growth and the anatomical repair rate were compared between the two groups.Results： The mean follow up time was（2.01±1.02）years. Nakata index and McGoon ratio equally increased significantly post operation as compared to baseline level（P〈0.001）. Incidence of final anatomical repair was significantly higher in the RV-PA group than in the systemic-to-pulmonary artery shunt group（62.2% vs 31.9%,P〈0.01）. During the anatomical repair operation, the incidence of cyanosis improvement was significantly higher, while the operation time was significantly shorter in the RV-PA group than in the systemic-to-pulmonary artery shunt group（both P〈0.05）. Mechanical ventilation time and ICU monitoring time also tended to be shorter in the RV-PA group（P〉0.05）.Conclusions： The palliative right ventricle to pulmonary artery connection surgery is related to higher rate of final anatomical repair in patients with pulmonary atresia and ventricular septal defect and may help the patients recover after the anatomical repair.

关 键 词：肺动脉闭锁合并室间隔缺损 肺动脉发育不良 姑息性右心室肺动脉连接术 体肺分流术 

分 类 号：R54[医药卫生—心血管疾病]