球囊扩张肺动脉瓣预防法洛四联症根治术后的疗效观察

摘要

目的：研究球囊扩张肺动脉瓣在预防法洛四联症根治术后肺动脉瓣反流的效果。方法：选择2012年1月-2015年1月实施全麻低温体外循环下法洛四联症根治术的36例患儿，根据右室流出道的修补方法将患者分为跨环补片组（n=19）和球囊扩张组（n=17）。分别在术后出院时和1年对两组患者进行超声心动图检查，测量肺动脉瓣环及Z值和肺动脉瓣反流程度。结果：跨环补片组中89.5%的患者出现术后中度及以上的明显肺动脉瓣反流（PR），重度反流患者比例达42.1%，而球囊扩张组中23.5%的患者有中度反流，无一例患者出现重度反流，两组比较差异均有统计学意义（P<0.001）。1年随访时，跨环补片组患者出现中度及以上明显PR的比例增加至94.4%，重度关闭不全的比例增加至61.1%，而球囊扩张组患者中度反流的比例虽然增加至35.3%，仍没有出现重度反流，两组比较差异均有统计学意义（P<0.001）。球囊扩张组患者术后出院和1年随访时肺动脉瓣环直径和Z值均有显著增加（P<0.001），逐渐达到正常水平（Z值>-2），说明球囊扩张术后肺动脉瓣环随时间迁移有明显生长。结论：对肺动脉瓣轻中度发育不良的法洛四联症患者，采用球囊扩张的方法原位保留肺动脉瓣可以有效预防术后肺动脉瓣反流。%Objective:To evaluate the efficacy of balloon dilatation pulmonary in the prevention of pulmonary regurgitation (PR) after surgical repair of tetralogy of Fallot(TOF).Method:A total of 36 cases with TOF were performed under hypothermia,general anaesthesia with cardiopulmonary bypass from January 2012 to January 2015.According to the methods of repair of right ventricular outflow tract,patients were divided into two groups:transannular patch group(n=19) and balloon dilation group(n=17).The pulmonary valve ring and Z value,the degree of PR was measured by echocardiograph at discharge and 1 year after operation respectively in two groups.Result:89.5% patients in transannular patch group get moderate and above degree of PR after surgery, and the proportion of severe degree of PR reached 42.1%.Only 23.5% of patients in balloon dilatation group get moderate degree of PR after surgery,and no patients had severe PR.There were statistically significant different between two groups(P<0.001).After 1 year,in transannular patch group,patients with moderate and above degree of PR increased to 94.4%,severe regurgitation ratio increased to 61.1%.In balloon dilation group,the proportion of moderate degree of PR increased to 35.3%,still did not appear severe degree of PR.There were statistically significant different between two groups(P<0.001).Pulmonary valve annulus diameter and Z value were increased significantly(P<0.001) and gradually reached the normal level(Z value>-2) from discharge to 1 year follow-up in balloon dilation group.It showed that pulmonary valve ring has obvious growth with time migration after the balloon dilatation.Conclusion:For the pulmonary valve with mild to moderate dysplasia in patients with tetralogy of Fallot,using balloon dilation to retain pulmonary can effectively prevent postoperative pulmonary regurgitation.