主-肺动脉间隔缺损的外科治疗

Surgical treatment of aortopulmonary septal defect

目的总结先天性主-肺动脉间隔缺损(APSD)的外科治疗经验。方法2000年10月到2009年3月共收治的主-肺动脉间隔缺损患者15例,年龄为2个月～5岁,平均1.8岁。按Richardson分形,Ⅰ型8例,Ⅱ型5例,Ⅲ型2例。其中Ⅰ型中2例经间隔缺损前壁径路涤纶补片修补,Ⅲ型中1例行人工血管右肺动脉-肺动脉干连接术,1例行直接切断右肺动脉与主肺动脉行端侧吻合。其余行经主动脉切口涤纶补片修补术,合并心脏畸形同期予以纠正。结果全组病例无死亡,8例随访5个月～3年,效果满意,复查超声心动图均无主-肺动脉残余分流,主动脉及肺动脉无狭窄,肺动脉压力较前明显下降。结论主-肺动脉间隔缺损(APSD)一经确诊应及早手术,手术年龄以婴儿早期为佳;术前诊断明确,充分认识病理生理及解剖类型,选择合适的手术方法是手术成功的关键。

Objective To summarize experience in surgical treatment of aortopulmonary septal defect（APSD）.Methods 15 patients with APSD were operated from October 2000 to January 2009.They were divided based on the Richardson′s classification： typeⅠ 8 cases,typeⅡ 5 cases,and type Ⅲ 2 cases.Among typeⅠ,2 cases received Dacron repair across of the frontal septal defect.Among type Ⅲ,1 case underwent the treatment with an artificial conduit connecting the RPA with MPA,another received the treatment of connecting the RPA directly with MPA.Others received Dacron repair across of the aorta.Results In the whole group,there was no operative death.8 patients had clinical improvement at a follow-up of 5 months to 3 years.There was no shunting,aorta and pulmonary artery stenosis.Pulmonary artery pressure obviously decreased.Conclusion This operation is suitable for young infants so as to avoid pulmonary vascular disease,and pre-operative accurate diagnosis and full understanding of pathophysiology and clinical anatomy are the keys for success.