Ozaki手术治疗儿童主动脉瓣疾病效果观察  

Ozaki procedure in pediatric aortic valve diseases

作　　者：魏志潘 张岩伟 郑家永 周司杰 李斌 范太兵 WEI Zhipan;ZHANG Yanwei;ZHENG Jiayong;ZHOU Sijie;LI Bin;FAN Taibing(Children's Heart Center,Fuwai Central China Cardiovascular Hospital,Heart Center of Henan Provincial People's Hospital,Zhengzhou,Henan 451464,China)

机构地区：[1]阜外华中心血管病医院儿童心脏中心河南省人民医院心脏中心,河南郑州451464

出　　处：《中华实用诊断与治疗杂志》2025年第2期112-116,共5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(LHGJ20230146)。

摘　　要：目的 分析行自体心包补片主动脉瓣成形术(Ozaki手术)患儿的临床资料,探讨Ozaki手术治疗儿童主动脉瓣疾病的效果。方法 2020年1月—2023年12月阜外华中心血管病医院诊治主动脉瓣疾病患儿20例,其中主动脉瓣狭窄2例,主动脉瓣关闭不全18例,均行Ozaki手术,记录手术方式、手术时间、体外循环时间、主动脉阻断时间,术后呼吸机使用时间、ICU停留时间,总住院时间,围手术期并发症发生情况及住院期间死亡情况。术前、术后1周、术后1年、术后3年、术后5年分别行心脏超声检查,比较主动脉瓣反流面积及主动脉瓣反流程度;比较术前及术后1周左室射血分数、左心房内径、左心室内径、右心房内径、右心室内径、主动脉瓣环内径Z评分;比较术后1、3、5年再发主动脉瓣病变率。结果 20例患儿中6例行单瓣叶Ozaki手术,14例行三瓣叶Ozaki手术。20例患儿均顺利出院,无手术失败转为主动脉瓣机械瓣膜、生物瓣膜置换术或自体肺动脉瓣移植术,未发生冠状动脉缺血等围手术期并发症及住院期间死亡;手术时间(270.05±58.33)min,体外循环时间(133.05±12.02)min,主动脉阻断时间(101.61±13.50)min;术后呼吸机使用时间(12.73±3.26)h, ICU停留时间(1.32±0.12)d,总住院时间(26.10±5.80)d。患儿术后1周左心房内径[(2.24±0.42)cm]、左心室内径[(3.25±0.45)cm]、右心房内径[(2.64±0.33)cm]、右心室内径[(2.21±0.37)cm]均小于术前[(3.12±0.67)、(3.91±0.63)、(3.02±0.43)、(2.57±0.45)cm](t=2.764~4.977,P均<0.05),主动脉瓣环内径Z评分(1.09±0.33)低于术前(2.12±0.55)(t=7.182,P<0.001)。主动脉瓣关闭不全患儿术前、术后1周、术后1年、术后3年、术后5年主动脉瓣中重度反流比率比较差异有统计学意义(χ^(2)=21.300,P<0.001),术后1周、1年、3年、5年主动脉瓣中重度反流比率(0、0、0、5.6%)均低于术前(100.0%)(P<0.05)。主动脉瓣关闭不全患儿术前、术后1周、术�Objective To analyze the clinical data of children undergoing autologous pericardial patch aortic valve plasty(Ozaki procedure),and to explore the surgical outcome of Ozaki procedure for treating pediatric aortic valve disease.Methods Twenty children with aortic valve disease underwent Ozaki procedure in Fuwai Central China Cardiovascular Hospital from January 2020 to December 2023,including 2 cases of aortic valve stenosis and 18 cases of aortic valve insufficiency.The surgical procedures and lasting time,extracorporeal circulation time,aortic cross-clamp time,duration of postoperative ventilator support,length of ICU stay,length of total hospital stay,perioperative complications,and in-hospital mortality were recorded.Echocardiography was performed before and 1 week,1 year,3 years and 5 years after surgery.The aortic valve regurgitation area and degree were compared.The left ventricular ejection fraction,left and right ventricular and atrial dimeters,and aortic annulus Z-score were compared before and 1 week after surgery.The incidence of recurrent aortic valve disease was compared 1,3 and 5 years after surgery.Results Among these 20 patients,6 underwent single leaflet Ozaki procedure,and 14 underwent triple-leaflet Ozaki procedure.All patients were successfully discharged without conversion to aortic valve mechanical/biological valve replacement or autologous pulmonary valve transplantation due to Ozaki failure.No perioperative complications as coronary artery ischemia or in-hospital mortality occurred.The surgery lasted for(270.05±58.33)min,with extracorporeal circulation time of(133.05±12.02)min and aortic cross-clamp time of(101.61±13.50)min.The postoperative ventilator support was required for(12.73±3.26)h,the length of ICU stay was(1.32±0.12)d,and the length of total hospital stay was(26.10±5.80)d.The left atrial diameter,left ventricular diameter,right atrial diameter,and right ventricular diameter were shorter1 week after surgery[(2.24±0.42),(3.25±0.45),(2.64±0.33),(2.21±0.37)cm]than those bef

关 键 词：主动脉瓣狭窄 主动脉瓣关闭不全 儿童 自体心包补片主动脉瓣成形术 Ozaki手术 

分 类 号：R54[医药卫生—心血管疾病]