人同种心包补片在法洛四联症分期手术中的应用

Cryopreserved Homograft Pericardium Patch in Staged Repair of Tetralogy of Fallot

目的比较人同种心包补片和Gore-tex补片在法洛四联症(tetralogy of Fallot,TOF)分期手术中扩大右心室流出道(right ventricular outflow tract,RVOT)的效果.方法 28例已行一期手术再行分期手术的TOF患者,按不同的二期或三期手术时间分为两组,Gore-tex组:13例,以Gore-tex补片扩大RVOT;人同种心包补片组:15例,以深低温冷冻保存的人同种心包补片扩大RVOT.比较两组术后临床结果和随访结果.结果 Gore-tex补片组术中死亡1例(7.7%),人同种心包补片组术后早期死亡1例(6.7%).人同种心包补片组住ICU时间、呼吸机使用时间和心包腔引流量均少于Gore-tex补片组(P＜0.01).所有患者均获得随访,随访时间0.8～4.5年,超声心动图检查提示Gore-tex补片组患者术后RVOT水平残余梗阻的比率高于人同种心包补片组(P＜0.01),胸部X线片未发现钙化影.结论人同种心包组织致密,缝合后不易渗血,止血方便;且具有良好的弹性和顺应性,有助于降低术后RVOT水平的残余梗阻发生,可作为补片材料在心脏外科手术中应用.

Objective To compare the difference of effect while using homograft pericardium patch and Gore- tex patch in staged repair of tetralogy of Fallot（TOF） to enlarge the right ventricular outflow tract （RVOT）. Methods Twenty-eight patients with TOF who underwent the staged complete repair were divided into 2 groups according to the date of surgery. Gore-rex group, 13 cases, their RVOT were enlarged with Gore-tex patches. Cryopreserved homograft pericardium patch group, 15 cases, their RVOT were enlarged with cryopreserved homograft pericardium patches. Clinical results and follow-up results were compared. Results There were 1 operative death in Gore-tex patch group （7. 7%）, and 1 early postoperative death in cryopreserved homograft pericardium patch group （6. 7%）. Hemostasia time, the pericardial cavity drainage volume in cryopreserved homograft pericardium patch group were less than those in Gore-tex patch group （P〈0. 01）. All patients were followed-up for 0.8-4.5years. The residual obstruction rate at RVOT level in Gore-tex patch group was higher than that in cryopreserved homograft pericardium patch group by echocardiography （P〈0.01）. No calcification shadow was found on the chest X-ray. Conclusion Homograft pericardium is the tissue with high density and intensity, its elasticity and compliance are good. Using homograft pericardium patch may be helpful to decrease the residual obstruction of RVOT after operation. It can be adapted as a repairing material in heart surgery.