Gore-Tex心包膜重建法洛四联症右心室流出道效果观察  

Application of Gore-Tex pericardium in reconstruction of right ventricular outflow tract in tetralogy of Fallot

作　　者：袁心刚 梁栋[1] 赵力运 梁维杰[1] 董好举[1] 宋书波[1] 范太兵[1] YUANXin-gang;LIANG Dong;ZHAO Liyun;LIANG Wei-jie;DONG Hao-ju;SONG Shu-bo;FAN Tai-bing(Heart Center,Henan Provincial People's Hospital,Central China Fuwai Hospital,Central China Fuuai Hospital of Zhengzhou University,Central China Branch of National Cardiovascular Center,Zhengzhou,Henan 451464,China)

机构地区：[1]河南省人民医院心脏中心华中阜外医院郑州大学华中阜外医院国家心血管病中心华中分中心,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2021年第5期477-480,共4页Journal of Chinese Practical Diagnosis and Therapy

基　　金：河南省医学科技攻关计划联合共建项目(2018020468)。

摘　　要：目的探讨法洛四联症根治术中应用Gore-Tex心包膜重建右心室流出道预防术后肺动脉瓣反流的效果。方法法洛四联症患儿60例,入院肺动脉瓣Z值-6.0~-2.3,均行法洛四联症根治术,术中应用0.1 mm厚的Gore-Tex心包膜制作肺动脉单瓣的跨环牛心包补片重建右心室流出道。记录手术情况及术后并发症发生情况;比较术前、术后即刻左室射血分数、左心室舒张末期容积指数;术后3、6个月及1、2、3年行经胸超声心动图,评估肺动脉狭窄、肺动脉反流发生情况及严重程度。结果手术均在体外循环辅助下完成,体外循环时间90~194(129±46)min,主动脉阻断时间60~137(92±18)min,术后右心室流出道压力阶差均<10 mm Hg。患儿术前左室射血分数[(61±12)%]与术后即刻[(62±9)%]比较差异无统计学意义(P>0.05),左心室舒张末期容积指数[(0.35±0.06)mL/m^(2)]低于术后即刻[(0.47±0.11) mL/m^(2)](P<0.05)。术后发生肺部感染1例经抗感染治疗后康复出院,少量心包积液3例和膜周部残余室间隔缺损1例临床随访观察,术后无死亡病例,未发生围术期严重并发症。术后即刻、术后3、6个月及1、2、3年,中度肺动脉瓣反流发生率分别为0、0、1.7%、1.7%、2.0%、0,中度肺动脉瓣狭窄发生率分别为0、3.3%、5.0%、5.0%、5.9%、4.9%,均未发生重度肺动脉瓣反流、重度肺动脉瓣狭窄。结论法洛四联症根治术中应用0.1 mm厚的Gore-Tex心包膜重建右心室流出道,可有效预防术后肺动脉瓣反流,近、中期疗效满意。Objective To investigate the effect of reconstruction of right ventricular outflow tract(RVOT) with Gore-Tex pericardium in radical surgery of tetralogy of Fallot on preventing postoperative pulmonary valve regurgitation. Methods Sixty children with tetralogy of Fallot and pulmonary valve Z-value of-6.0 to-2.3 at admission underwent Gore-Tex pericardial reconstruction of RVOT. Gore-Tex pericardium with thickness of 0.1 mm was used to reconstruct RVOT with a single pulmonary valve. The operation process and postoperative complications were recorded. Left ventricular ejection fraction and left ventricular end-diastolic volume index were compared before operation and immediately after operation. The occurrences and severities of pulmonary valve stenosis and pulmonary valve regurgitation were evaluated by transthoracic echocardiography in 3 months, 6 months, 1 year, 2 years and 3 years after operation. Results All these operations were completed with the assistance of cardiopulmonary bypass. Cardiopulmonary bypass lasted 90 to 194(129±46) min. Aortic crossclamp time was 60 to 137(92±18) min. The pressure gradient of RVOT was less than 10 mm Hg. There was no significant difference in left ventricular ejection fraction immediately after operation((62±9)%) compared with that before operation((61±12)%)(P>0.05). Left ventricular end-diastolic volume index was greater immediately after operation((0.47±0.11) mL/m^(2)) compared with that before operation((0.35±0.06) mL/m^(2))(P<0.05).Pulmonary infection occurred in 1 patient, which was cured and the patient was discharged after anti-infection therapy. Pericardial effusion occurred in three patients and residual perimembranous ventricular septal defect occurred in one patient. There was no death or serious perioperative complications. The incidences of moderate pulmonary valve regurgitation were 0, 0, 1.7%, 1.7%, 2.0% and 0, while the incidences of moderate pulmonary valve stenosis were 0, 3.3%, 5.0%, 5.0%, 5.9% and 4.9% immediately after operation, 3 months, 6 months,

关 键 词：法洛四联症 Gore-Tex心包膜 右心室流出道重建 肺动脉瓣反流 肺动脉瓣狭窄 

分 类 号：R654.2[医药卫生—外科学]