同种带瓣血管片在右心室流出道重建手术中的应用

Application of homologous blood vessel graft with valve in right ventricular outflow tract reconstruction

目的评估同种带瓣血管片在右心室流出道重建手术中的应用效果。方法在39例患法乐四联症行根治手术的患儿中,跨肺动脉瓣环加宽右室流出道者23例,其中采用同种带瓣血管片13例,自体心包(不带瓣)10例;另外16例仅用自体心包加宽右室流出道而不跨肺动脉瓣环。比较三组患儿手术前后主要临床资料。结果在跨环补片的两组中,同种瓣组患儿的总体外循环时间、术后呼吸机辅助时间和心脏病重症监护病房(CICU)停留时间均比心包补片组短(P<0.01)。自体心包不跨环补片加宽右室流出道者,主动脉阻断时间与跨环组相比差异有统计学意义(P<0.01),呼吸机辅助时间与同种瓣组相比差异有统计学意义(P<0.05),与心包跨环组相比差异有统计学意义(P<0.01),CICU停留时间与同种瓣组相比差异无统计学意义(P>0.05),与心包跨环组相比差异有统计学意义(P<0.05)。结论同种瓣血管片是加宽右室流出道的理想修复材料,其抗肺动脉瓣反流效果好,术后病情稳定,临床疗效等同于非跨环组。

Objective To evaluate the clinical results of homologous blood vessel graft with valve in right ventricular outflow tract （RVOT） reconstruction. Methods In 39 patients with tetralogy of Fallot （TOF）,homologous graft with valve was used in 13 cases;transannular graft of autologous pericardium without valve was used in 10 cases, while 16 cases received autogenous pericardium without transannular graft to enlarge RVOT.Their main clinical materials before and after operation were compared with each other. Results The two groups with transannular graft spent less time of total cardiopulmonary bypass （CPB）,A/C ventilation and CICU stay,compared with that group without transannular graft （P〈0.01）.Those who had received autogenous pericardium enlargement without transannular graft had an aortic blocking time markedly different from those with transannular graft （P〈0.01）;A/C ventilator time showed difference compared with homogenic valve group （P〈0.05） or compared with pericardium transannular group （P〈0.01） ;CICU stay did not vary with that of homogenic valve group （P〉0.05）,but varied with that of pericardium transannular group （P〈0.05）. Conclusion Autogenic blood vessel valve is an ideal material for enlarging right ventricular outflow,which gives a good effect against pulmonary arterial reflux,a stable postoperative condition to the patient,and an equal result to that of non-transannular group.