Rastelli术中应用同种带瓣管道的中远期结果分析  

Mid and long-term results of homograft conduits used in the Rastelli operation

作　　者：方敏华 张春振 张永 张旭 王镇龙 辛芳冉 Fang Minhua;Zhang Chunzhen;Zhang Yong;Zhang Xu;Wang Zhenlong;Xin Fangran(Department of Cardiovascular Surgery,General Hospital of Northern Theater Command,Shenyang 110016,China)

机构地区：[1]北方战区总医院心血管外科,沈阳110016

出　　处：《中华胸心血管外科杂志》2023年第10期590-593,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：辽宁省科技厅2019年重点研发计划(2019010211-JH8/103)。

摘　　要：目的总结Rastelli手术中应用冷冻保存同种带瓣管道的中远期结果,探索影响管道衰败和再次干预手术的危险因素。方法2002年4月至2013年12月,应用冷冻保存的同种带瓣管道完成52例Rastelli手术并长期随访,其中男36例,女16例,手术中位年龄4岁(3~14岁),中位体质量14 kg(10~36 kg)。术中应用同种主动脉瓣管道30例,肺动脉瓣管道22例,根据同种带瓣管道直径的大小分为3组:组Ⅰ(16 mm)22例,组Ⅱ(16~20 mm)22例,组Ⅲ(≥20 mm)8例。术后随访同种带瓣管道衰败的发生时间和病理改变。结果术后随访中位时间12年(7~18年),所有患儿随访中都出现不同程度的同种带瓣血管衰败,衰败的主要病理改变是管道狭窄。37例患儿因为同种带瓣管道严重衰败接受右心室流出道再次重建手术,两次手术中位间隔时间12年(9~18年)。单因素统计学分析结果显示,影响同种带瓣血管术后发生衰败时间的危险因素是手术年龄<5岁(P<0.001),同种带瓣管道的直径大小(P<0.001),Rastelli手术后右心室/主动脉压比值>0.5(P=0.002)。影响再次干预手术的危险因素只有手术年龄<5岁。结论对于小年龄的患儿,选用偏大号的同种带瓣管道,采用Gore-Tex人工血管与扩大的右心室切口吻合,可以延迟管道衰败和再次干预手术的时间。Objective To study the mid-and long-term outcomes of the cryopreserved homograft conduits used in the Rastelli operation and to identify the risk factors for the homograft conduit degeneration and reintervention.Methods 52 patients were followed up from 7 to 18 years,who accepted the Rastelli operation with cryopreserved homograft conduits between April 2002 and December 2013.There were 36 male and 16 female with age ranged 3 to 14 years old(median age 4 years old)and weight ranged 10 to 36 kg(median weight 14 kg).The homografts included aortic homografts implanted in 30 cases and pulmonary homografts implanted in 22 cases.The homograft conduits were divided into three groups by conduit diameter:groupⅠ(16 mm)22 cases,groupⅡ(16-20 mm)22 cases and groupⅢ(≥20 mm)8 cases.The pathological characteristics of homografts were studied in the period of follow-up.Results 52 patinets were followed up from 7 to 18 years(median time 12 years).Over the follow up period,all homograft conduits had structural valve degeneration.The predominant pathological characteristics was stenosis of conduits.37 patinets had received the reoperation because of the homograft degeneration.The interval between the first and reoperation is ranged 9 to 18 years(median time 12 years).Univariate analysis demonstrated young operation age(<5 years old)(P<0.001),diameter of the homograft conduit(P<0.001),high right ventricular pressure(RV/Ao P>0.5)after Rastelli operation(P=0.002)were independent risk factors for the homograft conduit degeneration.Univariate analysis demonstrated only young operation age(<5 years old)(P=0.03)was independent risk factor for the reoperation.Conclusion In young patients,oversize homograft conduit and enlarge incision with Gore-Tex conduit may improve durability and decay the time of reintervention.

关 键 词：同种带瓣管道 Rastelli手术 衰退 再次手术 

分 类 号：R726.5[医药卫生—儿科]