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|本期目录/Table of Contents|

错过最佳手术时机的永存动脉干的一期矫治(PDF)

《心脏杂志》[ISSN:1009-7236/CN:61-1268/R]

期数:
2012年第1期
页码:
88-89,96
栏目:
临床研究
出版日期:
2012-02-25

文章信息/Info

Title:
Repair of truncus arteriosus beyond optimal timing of surgery
作者:
田良鑫; 闫 军; 罗国华; 李守军
(中国医学科学院阜外心血管病医院外科，北京 100037)
Author(s):
TIAN Liang-xin;  YAN Jun;  LUO Guo-hua;  LI Shou-jun
(Department of Surgery, Cardiovascular Institute and Fu Wai Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100037, China)
关键词:
永存动脉干; 肺动脉高压; 牛颈静脉带瓣管道; 同种肺动脉带瓣管道
Keywords:
persistent truncus arteriosus;  pulmonary hypertension;  bovine jugular conduit;  pulmonary homograft
分类号:
R654.2
DOI:
-
文献标识码:
A
摘要:
目的:总结错过最佳手术时机的永存动脉干一期矫治术结果及经验。方法： 2008年6月~2010年7月，我院连续收治14（男6，女8）例永存动脉干患者，年龄0.6～18（4±5）岁，均大于公认的最佳手术年龄。在全麻低温体外循环下行一期矫治术，以牛颈静脉或同种肺动脉带瓣管道连接右心室至肺动脉。结果： 术后早期死亡1例。二次开胸1例，术后随访13例，随访时间0.6～2.2(1.6±0.7)年，随访中无死亡。随访期内心功能均较出院时改善。结论： 错过最佳手术时机的永存动脉干只要严格掌握适应证，处理肺动脉高压问题，则行一期矫治术成功率高，近期随访结果满意。
Abstract:
AIM:To review the experience and outcomes of one-stage repair of truncus arteriosus (TA) in patients who were beyond the optimal time for surgical repair. METHODS: From June 2008 to July 2010, 14 patients (6 males and 8 females) underwent one-stage repair of TA with pulmonary hypertension under hypothermia cardiopulmonary bypass. Mean age of the patients was (4±5) years (range 0.6-18 years). Patients were much older than the generally accepted optimal age for surgical repair. Mean pulmonary artery pressure ranged from 56 to 101 mmHg and right ventricle-pulmonary artery continuity was reconstructed in six patients with a pulmonary homograft conduit and in eight patients using a bovine jugular conduit. RESULTS: There was one in-hospital death and one case requiring reexploration for postoperative bleeding. During a mean follow-up of (1.6±0.7) years, no late deaths occurred and heart functions improved in the 13 survivors. CONCLUSION: Satisfactory outcomes are obtained in patients with TA who have passed the optimal age for surgical repair, using either a pulmonary homograft or a bovine jugular conduit. Long-term follow-up is needed for possible conduit failure or dysfunction.

参考文献/References

[1]Mavroudis C,Backer CL.Pediatric Cardiac Surgery[M].St Louis:CV Mosby,2003:339-352．

[2] Raisky O,Ali WB,Bajolle F,et al.Common arterial trunk repair: with conduit or without?[J].Eur J Cardiothorac Surg,2009,36(4):675-682.

[3]Sinzobahamvya N,Boscheinen M,Blaschczok HC,et al.Survival and reintervention after neonatal repair of truncus arteriosus with valved conduit[J].Eur J Cardiothorac Surg,2008,34(4):732-737.

[4]Lacour-Gayet F,Serraf A,Komiya T,et al.Truncus arteriosus repair:Influence of techniques of right ventricular outflow tract reconstruction[J].J Thorac Cardiovasc Surg,1996,111(4):849-856.

[5]Danton MH, Barron DJ,Stumper O,et al.Repair of truncus arteriosus:A considered approach to right ventricular outflow tract reconstruction[J].Eur J Cardiothorac Surg,2001,20(1):95-104.

备注/Memo

备注/Memo:
收稿日期：2011-04-26.通讯作者：闫军，主任医师，主要从事先天性心脏病研究 Email:yanjun.1112@yahoo.com.cn 作者简介：田良鑫，副主任医师，硕士 Email:liangxin_tian@hotmail.com
更新日期/Last Update: 2012-02-14