锥形心包管道重建右心室流出道在Ⅲ型肺动脉闭锁/室间隔缺损治疗中的应用

摘要

Objective To summarize the outcomes of reconstructing right ventricular outflow tract with conical perucardial conduit in type Ⅲ pulmonary atresia with ventricular septal defect (PA/VSD).Methods We retrospectively analyzed the clinical data of 7 patients with type Ⅲ PA/VSD who underwent surgical repair in the Department of Cadiovascular Surgery,Guangdong Cardivascular Institute from January 2012 to August 2014.There were 3 males and 4 females at a median age of 2.5 years (range,1.4 to 10.8 years) and a mean weight of(11.4 ± 3.4) kg.All patients were underwent right ventricular outflow tract reconstruction with conical pericardial conduit.Results The mean bypass time was (132.7 ± 32.5) min,the mean aorta cross-clamping time was(71.9 ± 15.1) min.There was 1 patient with diaphragmatic paralysis and 1 patient with chylothorax,both of whom were underwent surgical intervention.There was 1 patient with postoperative pneumonia.The ventilation time was 17.8-356.9 hours.There was no in-hospital death.The mean ICU stays was 2.8-21.5 days and the mean hospital stays was 13-74 days.All patients were alive and no severe anoxia during follow-up.Conclusion The early outcomes of reconstructing right ventricular outflow tract with conical pericardial conduit in type Ⅲ PA/VSD was good.Preoperative evaluation of the pulmonary development and MAPCAs were helpful for making rational choice.%目的 总结并分析锥形心包管道重建右心室流出道的手术方法治疗Ⅲ型肺动脉闭锁/室间隔缺损患者的疗效.方法 2012年1月至2014年8月,广东省心血管病研究所心外科诊治7例Ⅲ型肺动脉闭锁/室间隔缺损患儿,回顾性分析其临床资料.男3例,女4例;年龄1.4～10.8岁,中位年龄2.5岁;体质量8～17 kg,平均(11.4±3.4) kg.均采用锥形心包管道重建右心室流出道.结果 6例同期行侧支单一化,体外循环97～ 174 min,平均(132.7 ±32.5) min;主动脉阻断57～ 99 min,平均(71.9±15.1) min.术后1例膈肌麻痹行膈肌折叠术,1例乳糜胸行胸导管结扎,1例肺部感染;使用呼吸机17.8～ 356.9 h.无术后死亡,住ICU 2.8～ 21.5天,总住院13～ 74天.随访期间患儿无死亡,无严重缺氧.结论 锥形心包管道行右心室流出道重建,效果良好,术前全面评估固有肺动脉的发育情况及主肺侧支动脉,有助于术中选择合理的处理方式.