2025 年第 1 期 第 20 卷

复杂先天性心脏病矫治术后吻合口漏介入治疗4例并文献复习

Interventional treatment of anastomotic leakage after repair of complex congenital heart disease: 4 cases report and literature review

作者：栗政伟  胡海波  吕建华  刘琼  潘湘斌

英文作者：Li Zhengwei Hu Haibo Lyu Jianhua Liu Qiong Pan Xiangbin

单位：中国医学科学院北京协和医学院国家心血管病中心阜外医院结构性心脏病中心，北京100037

英文单位：Center of Structural Heart Disease Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Peking Union Medical College Beijing 100037 China

关键词：先天性心脏病；  外科矫治术；  残余漏；  瓣周漏；  介入封堵

英文关键词：Congenitalheartdisease;  Surgicalrepair;  Residualleakage;  Paravalvularleakage;  Interventionalocclusion

• 摘要：

• 吻合口漏是复杂先天性心脏病（先心病）外科矫治术后较常见的一种并发症。当漏口较小时可随着时间推移自发闭合，这种情况下可采取保守治疗或不治疗。当漏口较大时，会引起血流动力学紊乱，严重者可导致心力衰竭或猝死，需要对其进行手术干预。既往再次外科开胸手术是这类吻合口漏的主要治疗方式，但外科手术往往需要再次开胸、体外循环、全身麻醉，不仅创伤大、风险高，而且由于首次术后心包及周围组织粘连，再次手术的难度也明显增加。近年来，随着先心病介入技术的发展，介入治疗以其微创、效果确切、可重复性好、并发症少等优点，逐渐成为二次外科手术一种较理想的替代方案。目前，临床上有关复杂先心病外科矫治术后吻合口漏介入治疗的病例报道较少，本文报告了4例这类疾病的介入封堵成功病例并系统复习了相关文献，以期为临床上对这类疾病的处理提供新的思路。

• Anastomotic leakage is a common complication after surgical repair of complex congenital heart disease (CHD). When the leakage is small, it may close spontaneously over time, in which case it may be treated conservatively or without treatment. When the leakage is large, it will cause hemodynamic disorder, and in severe cases, it can lead to heart failure or sudden death, requiring surgical intervention. In the past, reoperation was the main treatment for this type of anastomotic leakage. However, surgery often requires reoperation, cardiopulmonary bypass, and general anesthesia, which not only causes great trauma and high risk, but also increases the difficulty of reoperation due to the adhesion of pericardium and surrounding tissues after the first operation. In recent years, with the development of interventional technology for CHD, interventional therapy has gradually become an ideal alternative to secondary surgery due to its advantages of minimally invasive, exact effect, good repeatability and few complications. At present, there are few clinical cases of interventional treatment of anastomotic leakage after surgical repair of complex CHD. This paper reported four cases of successful interventional closure of anastomotic leakage after surgical repair of complex CHD and systematically reviewed the relevant literature, in order to provide new ideas for clinical treatment of this disease.