改良Nikaidoh术治疗大动脉转位或右室双出口合并室间隔缺损、肺动脉狭窄的早中期结果  

Immediate and middle-term outcome of modified Nikaidoh operation for transposition of great arteries or double-outlet right ventricle with ventricular septal defect and pulmonary stenosis

作　　者：宋杰[1] 张达雄[1] SONG Jie;ZHANG Daxiong(Department of Cardiac Surgery,Wuhan Asia Heart Hospital,Hubei 430022,China)

机构地区：[1]武汉亚洲心脏病医院心外科,430022

出　　处：《国际心血管病杂志》2018年第2期94-97,共4页International Journal of Cardiovascular Disease

摘　　要：目的:观察改良Nikaidoh术治疗大动脉转位(TGA)或右室双出口(DORV)合并室间隔缺损(VSD)、肺动脉狭窄(PS)的早中期随访结果。方法:2007年1月至2016年12月在武汉亚洲心脏病医院共行改良Nikaidoh手术34例,其中22例为TGA/VSD/PS,12例为DORV/VSD/PS,患者中位年龄1.5岁(3个月~26岁),中位体质量11kg(6~42 kg)。手术均以改良Nikaidoh术为主要术式。结果:平均体外循环时间(160±46)min,主动脉阻断时间(119±36)min,重症监护室滞留时间(120±45)h,住院时间(18±11)d。早期死亡3例,延迟关胸6例,严重并发症7例(开胸止血3例、Ⅲ度房室传导阻滞1例、室间隔中等大小残余分流1例、单侧膈肌麻痹1例、因肺动脉瓣严重反流而置换牛颈静脉管道1例)。随访中位时间64个月(9~115个月),1例因PS、右心衰竭于术后第8年再次手术后死亡;其余30例均未行二次手术,临床心功能Ⅰ~Ⅱ级,无左、右室流出道进行性梗阻病例,无冠状动脉缺血表现,无中度以上主动脉瓣反流,1例肺动脉瓣重度反流。结论:改良Nikaidoh术治疗合并VSD和PS的心室大动脉连接异常,并不增加围术期死亡率,中期随访效果满意,可作为首选术式。Objective:To investigate the immediate and middle-term outcome of modified Nikaidoh operation for transposition of great arteries(TGA)or double-outlet right ventricle(DORV)with ventricular septal defect(VSD)and pulmonary stenosis(PS).Methods:Thirty-four hospitalized cases who underwent modified Nikaidoh operation in Wuhan Asia Heart Hospital from January.2007 to December.2016 were included in the study.Twenty-two were diagnosed as TGA/VSD/PS,the others were DORV/VSD/PS.The median age at operation was 1.5 years old(3 months to 26 years old)and the median body weight was 11 kg(6 to 42 kg).Results:There were 3 hospital deaths,6 delayed sternal closures and 7 severe complications,which included 3 postoperative hemostasis by thoracotomy,1 complete atrioventricular block,1 medium-size residual shunt in interventricular septum,1 diaphragmatic paralysis and 1 replacement of bovine jugular vein conduit due to severe pulmonary regurgitation.At a median follow-up of 64 months(9 to 115 months),one patient accepted second operation due to PS and right heart failure 8 years after opertion and died,the other 30 cases were all alive and free from reoperation.All cases have cardiac function grade I～II.There was no patient with progressive obstruction of left or right ventricular outflow tract,manifestation of coronary ischemia and over middle degree aortic regurgitation,while 1 case had severe pulmonary regurgitation.Conclusions:Modified Nikaidoh operation for TGA/VSD/PS or DORV/VSD/PS could be the first choice for these kinds of congenital heart disease due to satisfactory mid-term outcome with no increase of perioperatine mortality.

关 键 词：Nikaidoh术 大动脉转位 右室双出口 肺动脉狭窄 室间隔缺损 

分 类 号：R654[医药卫生—外科学]