体-肺侧支栓塞术在重症法洛四联症“一站式”杂交治疗中的临床价值

Application of transcatheter embolization of aortopulmonary collateral vessels in patients with severe tetralogy of fallot in one-stop procedure operation room:a comparative study

目的评价体-肺侧支栓塞术在重症法洛四联症（F4）患者“一站式”杂交治疗（介入治疗＋外科根治术）中的临床价值。方法2007年5月至12月,共26例重症F4患者（男12例,女14例）,平均年龄5.2岁（5个月~29岁）,在我院Siemens杂交手术室系统内完成了“一站式”治疗：全麻插管下先完成主动脉及心室造影,若发现有明确的体-肺侧支血管即予以经导管栓塞,随后立即完成外科根治术（杂交组）。选择同期住院仅接受单纯外科根治术的26例重症F4患者作为对照组（单纯外科组）。两组患者在性别、年龄、体重组成方面差异无统计学意义。对两组患者的住院时间、术后ICU监护时间、呼吸机辅助时间、体外循环时间等指标进行对比研究。结果杂交组中有20例患者接受了体-肺侧支栓塞术,其中2例因侧支血管太细放弃栓塞、4例未发现明确体-肺侧支血管。共采用Cook不可控弹簧圈50枚栓塞了38支侧支血管,另有两例采用明胶海绵团块栓塞侧支血管,所有患者均获栓塞成功,无异位栓塞发生。杂交组术后恢复良好,无死亡病例。单纯外科组有两例患者外科术后发生“灌注肺”现象,术后2~5d内接受了补救性体-肺侧支栓塞术,1例死于术后心功能不全。杂交组较对照组总住院时间（19.5d比25.6d）、术后ICU监护时间（50.3h比82.6h）、术后呼吸机辅助时间（18.5h比38.6h）和术中体外循环时间（105.1min比131.3min）均要明显缩短（均为P〈0.05）。结论外科术前体-肺侧支栓塞术能缩短手术时间、提供良好手术野、减少术后灌注肺的发生,在F4患者“一站式”杂交治疗能提高外科根治术的疗效及预后。

Objective To evaluate the clinical value of transcatheter embolization of aortopulmary collateral vessels in patients with severe tetralogy of Fallot （F4） cooperate with surgical repair in one-stop procedure operation room （ Siemens hybrid operation room system）. Methods From May to November 2007, a total of 24 patients with severe F4 （ 12 males, 12 females） , aged from 5 months to 29 years （average 52. 6 ± 88.1 months ）, were performed with one-stop hybrid procedure （hybrid group ）. Angiography was performed before surgery, and transcatheter embolization would be performed if the diameter of collateral vessels ≥ 2 mm before surgical repair. During the same period, 24 F4 patients with similar sex, age, weight and clinical status who received surgical repair without angiography before-operation in conventional operation room were selected as the control group. Results Twenty out of the 24 patients underwent transcatheter embolization in the one-stop procedure operation room. Thrity eight collateral vessels were occluded successfully with 50 coils （Cook corporation） which diameter ranged from 3mm to 8mm without any complication. No collateral vessel was found by angiography in 4 patients, and surgical procedure underwent directly. No in-hospital mortality was recorded in the hybird group. In the control group, 2 patients were underwent transcatheter embolization as remedy due to extensive pulmonary perfusion,and 1 patient died of congestive heart failure. Compared with the control group, the total days of hospitalization, the time of PICU, the time of respirator assistant and the time of on-pump of the hybrid group were significantly shortened （ 19. 5 ± 6. 8 days vs 25.6 ±10. 9 days, 50. 3 ± 42. 1 hrs vs 82. 6 ± 60.0 hrs, 18. 5 ± 15.7 Ins vs 38. 6 ±43.2 hrs, 105. 1 ±30. 7 mins vs 131.3 ±43.7 mins, respectively, P 〈0. 05）. Conclusion Hybrid approoches of F4 with transcatheter embolization of collateral vessels in the one-stop procedure operation room can simplify surgical operation and enhances surgical outcomes.