单侧肺动脉缺如再血管化治疗的早中期结果分析  

Early and mid-term results of surgical revascularization of pulmonary artery in unilateral absence of a pulmonary artery

作　　者：李文雷 马力[1] 陈伟丹[1] 夏树亮[1] 邹明晖[1] 陈欣欣[1] Li Wenlei;Ma Li;Chen Weidan;Xia Shuliang;Zou Minghui;Chen Xinxin(Heart Center,Guangzhou Women and Children's Medical Center,Guangzhou Medical University,Guangdong Provincial Clinical Research Center for Child Health,Guangzhou 510623,China)

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心广东省儿童健康与疾病临床医学研究中心心脏中心,广州510623

出　　处：《中华胸心血管外科杂志》2022年第10期581-585,共5页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：国家自然科学基金(青年科学基金项目81800280)。

摘　　要：目的总结分析单侧肺动脉缺如肺动脉再血管化外科治疗早中期结果。方法回顾性分析2009年1月至2020年12月,14例实施肺动脉再血管化手术的单侧肺动脉缺如患儿的临床资料。男7例,女7例;其中左肺动脉缺如4例,右肺动脉缺如10例;中位年龄5个月(16天至6岁)。11例为孤立性单侧肺动脉缺如,2例合并法洛四联症,1例合并主-肺动脉间隔缺损。所有患儿均在术前通过心血管CT或肺静脉逆行造影术明确患肺供血及肺门肺动脉残迹,并在术中探查明确诊断,肺动脉残迹直径(3.20±0.94)mm,Z值-3.92±1.64。所有患儿均接受一期手术治疗,手术方式根据术中肺门肺动脉残迹与主肺动脉是否使用管道连接分为两组:以人工血管(3例)或自体心包管道(5例)连接肺动脉残迹至主肺动脉(A组),采用直接吻合(2例)或体肺侧枝单源化术(1例)或主肺动脉翻片成形(3例)新建患侧肺动脉(B组)。结果所有患儿无手术早期死亡,两组患儿的手术年龄、体质量、体外循环、呼吸机使用、监护室滞留差异均无统计学意义。术后常规使用阿司匹林抗凝6个月。随访1~68个月,无中、远期死亡。B组1例患儿术后41个月因吻合口狭窄行经皮导管球囊扩张术。所有患儿无呼吸道症状或心功能不全表现,末次超声心动图示患侧新肺动脉直径(6.25±0.99)mm,Z值-2.34±1.18(-4.52~-1.35),较术前明显改善,血流速度1.0~2.5 m/s。无中重度三尖瓣反流,提示无肺动脉高压。B组患侧肺动脉术后Z值较A组显著改善。结论对于单侧肺动脉缺如的患者,早期且积极的再血管化外科重建,可有效恢复流向患肺的正常顺行血流,从而改善肺动脉直径和患者症状。特别是较多采用自体肺动脉组织进行血管成形,肺动脉生长更好。术后经导管介入治疗可能会暂时减轻新建肺动脉狭窄,远期再手术仍待进一步随访。Objective To summarize the early and middle terms of the revascularization of remnant pulmonary artery in unilateral absent intrapericardial pulmonary artery.Methods We retrospectively analyzed the medical records of 14 patients(7 males and 7 females)with unilateral absent pulmonary artery,in which 10 were right and 4 were left,the median age at surgery was 5 months.The patients received operation from January 2009 to December 2020.14 patients,2 cases associated with tetralogy of Fallot,and 1 case with aortopulmonary window.The diagnosis was made by enhanced CT scan or pulmonary vein wedge angiography.The median diameter of the affected hilar pulmonary artery remnants was(3.20±0.94)mm,and the Z value was-3.92±1.64.All the patients received single-stage revascularization:group A:tube graft interposition in 3 patients,autologous pericardial roll in 5;group B:direct anastomosis in 2,unifocalization in one and main pulmonary artery flap angioplasty in the rest 3.Results No hospital death occurred.There were no difference finds in the age and weight at operation,the cardiopulmonary bypass time,the mechanical ventilation time,and the length of intensive care unit stay between the two groups.All the patients took aspirin for anticoagulation for 6 months after the operation.The follow-up period was 1 month to 68 months.Because the neo-PA stenosis at the anastomosis was found in one patient in group B,transcatheter balloon angioplasty was performed at 41 months after surgery.Nonetheless,the results were encouraging,symptoms have improved in all patients.The diameter and Z value of the latest ipsilateral pulmonary artery was(6.25±0.99)mm and-2.34±1.18 respectively,significantly improved when compared to the preoperative value.Residual pulmonary artery hypertension was not found.The Z value of the affected side of the pulmonary artery in group B was significantly improved than that in group A.Conclusion Early and aggressive pulmonary artery revascularization is effective at restoring normal antegrade flow to the affecte

关 键 词：单侧肺动脉缺如 肺血管再血管化 

分 类 号：R726.5[医药卫生—儿科]