2022 年第 7 期 第 17 卷

复杂先天性心脏病两种带瓣管道重建技术的比较研究

Comparative study of two valved conduit reconstruction techniques for complex congenital heart disease

作者：吴永涛王栋金灿王执一王伊然苏俊武范祥明

英文作者：Wu Yongtao Wang Dong Jin Can Wang Zhiyi Wang Yiran Su Junwu Fan Xiangming

单位：首都医科大学附属北京安贞医院小儿心脏中心，北京100029

英文单位：Pediatric of Cardiac Center Beijing Anzhen Hospital Capital Medical University Beijing 100029 China

关键词：

英文关键词：Complexcongenitalheartdisease;Valvedconduit;Rightventricularpulmonaryarteryreconstruction

• 摘要：

• 目的 比较复杂先天性心脏病矫治术中两种带瓣管道重建右心室-肺动脉连接技术的优劣。方法 回顾性选取2012年1月至2017年12月于首都医科大学附属北京安贞医院诊治的复杂先天性心脏病外管道重建右心室-肺动脉连接患儿37例。按照重建右心室流出道手术方式不同分为2组：Ⅰ组为人工管道后三分之一与右心室流出道切口吻合，吻合口前壁加盖心包补片扩大吻合口（传统方法），共11例；Ⅱ组为人工管道近端与右心室流出道切口直接吻合，共26例。比较2组体外循环时间、主动脉阻断时间、呼吸机辅助通气时间、监护室滞留时间、术后肺动脉瓣压差。随访2组肺动脉瓣压差及反流情况。结果 2组体外循环时间、主动脉阻断时间、监护室滞留时间、呼吸机辅助通气时间、术后肺动脉瓣压差比较，差异均无统计学意义（均P＞0.05）。Ⅰ组患者远期随访8例，随访率为72.7%（8/11），随访时间1～6年。有1例因管道狭窄二次手术。随访期间无死亡患者。超声心动图结果显示，肺动脉瓣大量反流1例，少量反流3例，肺动脉瓣压差（15±11）mmHg（1 mmHg=0.133 kPa）、范围4～32 mmHg。Ⅱ组患者远期随访23例（前期有1例于术后12 d突发心跳骤停死亡），随访率92.0%（23/25），随访时间8个月~7年。随访期间死亡1例，死因为感染性心内膜炎，心功能衰竭。超声心动图检查显示，肺动脉瓣中量反流1例，少量反流6例，微量反流4例，肺动脉瓣压差（17±16）mmHg、范围4～66 mmHg。结论 人工管道近端与右心室流出道切口直接吻合重建右心室-肺动脉连接，理论上存在狭窄和瓣膜反流的隐患，但与传统方法比较，没有明显差异

• Objective To compare the advantages and disadvantages between two kinds of right ventricular pulmonary artery reconstruction techniques in complex congenital heart disease. Methods Thirty-seven patients with complex congenital heart disease who underwent right ventricular pulmonary artery reconstruction in Beijing Anzhen Hospital, Capital Medical University from January 2012 to December 2017 were selected retrospectively. According to the different surgical approaches of reconstructing the right ventricular outflow tract, they were divided into two groups. In group Ⅰ, the latter third of the artificial pipeline was anastomosed with the incision of the right ventricular outflow tract, and the upper part was covered with pericardial patch to expand the anastomosis, including 11 cases; in group Ⅱ, the proximal end of the artificial tube was anastomosed directly to the right ventricular outflow tract incision, including 26 cases. The cardiopulmonary bypass time, aortic cross clamp time, ventilator time, intensive care unit (ICU) time and postoperative pulmonary artery pressure difference were compared between the two groups. The pulmonary valve pressure difference and regurgitation in the two groups were followed-up. Results There were no significant differences in cardiopulmonary bypass time, aortic cross clamp time, ICU time, ventilator time, and postoperative pulmonary artery pressure difference between the two groups(allP＞0.05). Eight patients in group Ⅰ were followed-up for 1 to 6 years, with a follow-up rate of 72.7% (8/11). One case underwent secondary operation due to pipeline stenosis. There were no deaths during follow-up. The echocardiography showed that 1 case had massive pulmonary regurgitation, 3 cases had a little pulmonary regurgitation, and the pulmonary valve pressure difference was (15±11) mmHg, ranging from 4 to 32 mmHg. Twenty-three patients in group Ⅱ were followed-up for 8 months to 7 years (one case died due to cardiac arrest 12 d after operation), with a follow-up rate of 92.0% (23/25). One case died during the follow-up period because of infective endocarditis and heart failure. Echocardiography showed 1 case of moderate pulmonary valve regurgitation, 6 cases of a little regurgitation and 4 cases of minor regurgitation. The pulmonary valve pressure difference was (17±16)mmHg and the range was 4 to 66 mmHg. Conclusion The artificial pipeline is directly anastomosed with the right ventricular outflow tract incision end to side, which is a hidden danger of stenosis and valve regurgitation in theory, but there is no significant difference compared with the traditional method.