活性带瓣自体心包补片在右室流出道重建中的应用

Autologous Pericardial Monocusp with Bioactivity in Rereconstruction of the Right Ventricular Outflow Tract

目的:探讨经蒸馏水处理的活性带瓣自体心包补片在右室流出道重建中的应用,并与单纯心包补片的临床效果进行比较。方法:分别选取2003年6月—2006年5月连续50例采用经蒸馏水处理的活性带瓣自体心包补片进行右室流出道重建患者。和2000年6月—2003年5月连续39例采用单纯自体心包补片进行右室流出道重建患者,比较两组的临床结果。结果:带瓣补片组均痊愈出院,随访1～36个月,无明显右心功能不全表现;单纯补片组除术后早期死亡1例外均痊愈出院,随访37～72个月,有4例患者反复腹胀、下肢浮肿,需长期服用利尿剂。两组患者的年龄、主动脉阻断时间、体外循环时间、术前/后肺动脉瓣上最大流速之间均无显著差异,带瓣补片组术后机械通气时间短于单纯补片组(P<0.05),而单纯补片组术后1周肺动脉瓣中度和重度返流的患者所占比率明显高于带瓣补片组。结论:应用经蒸馏水处理的活性带单瓣自体心包补片进行右室流出道重建,有助于降低术后肺动脉瓣返流程度,有利于患者术后心功能的恢复,取得了良好的早中期效果。

Objective：To study the results of reconstruction of the right ventricular outflow tract （RVOT） using autologous pericardial monocusp treated with distilled water, and compare its effect with no-valve pericardial patch. Methods .. Between June 2003 and May 2006, 50 consecutive patients underwent rereconstruction of RVOT with autologous pericardial monocusp treated by distilled water and between Jun 2000 and May 2003, 39 continuous patients underwent rereconstruction of RVOT with novalve pericardial patch. Their clinical results were compared. Results.. There was no death and postoperative right heart failure in monocusp group. There was one early death and four patients with repeatedly postoperative right heart failure in no-valve group. The number of patients with moderate-severe postoperative pulmonary insufficiency in no-valve group was more than monocusp group. Conclusion： Reconstruction of RVOT using autologous pericardial monocusp treated with bioactivity is beneficial to lower the postoperative pulmonary insufficiency, and enhance the heart function. The early-moderate results of this procedure are satisfactory.