带单瓣自体心包补片在右室流出道重建术中的临床研究

Clinical Research on Autologous Pericardial Monocuspid Valve Patch in the Reconstruction of Right Ventricular Outflow Tract

目的研究带单瓣自体心包补片在右心室流出道重建术中的应用价值。方法 2006-07/2010-12月期间收治的48例复杂先天性心脏病患者行右心室流出道重建手术,其中法洛四联症（tetralogy of Fallot,TOF）21例,法洛四联症合并肺动脉闭锁（pulmonary atresia,TOF＋PA）12例,右心室双出口合并肺动脉瓣狭窄（double outlet right ventricleand pulmonary stenosis,DORV＋PS）10例,永存动脉干（persistent truncus arteriosus,PTA）5例;男30例,女18例,年龄0.8~16.0（5.2±4.1）岁;术中采用自体心包补片加宽右室流出道,再剪一小块半圆形心包设计成单瓣,缝制于心包补片上,其直径相当于重建后肺动脉瓣环直径。术后随访39例,9例失访,时间2~36（17.1±9.5）月。结果术后无死亡患者,无右室流出道再狭窄,超声显示术后早期血液动力学效果满意;但术后2年只有20%（2/10）患者仍保存正常的肺动脉瓣功能。结论采用带单瓣自体心包补片行右室流出道重建术,操作简便、安全,术后早期能极好的阻止肺动脉瓣返流,其作用虽不能持久,但远期也不会出现右室流出道再狭窄,适当选用能降低围手术期损伤。

Objective To evaluate the application value of right ventricular outflow tract（RVOT） reconstruction with an autologous pericardial monocuspid valve patch to prevent pulmonary regurgitation.Methods Forty-eight patients were treated between July 2006 and December 2010,including patients with tetralogy of Fallot（TOF,21 cases）,TOF and pulmonary atresia（TOF＋PA,12 cases）,double outlet right ventricle and pulmonary stenosis（DORV＋PS,10 cases）,persistent truncus arteriosus（PTA,5 cases）.A total of 30 males and 18 females aged 0.8-16.0（5.2±4.1） years received surgical correction with RVOT reconstruction with autologous pericardial monocuspid valve patch.During the operation,the RVOT was enlarged with the autologous pericardial patch,and a predesigned part of the pericardial patch was folded to form a monocuspid valve,which was stitched along with the pericardial patch.Postoperational follow-up was conducted for 2-36（17.1±9.5） months.Results No surgical mortality and RVOT restenosis were recorded after operation.The postoperative early haemodynamics effects were satisfying.But only 20% patients reserved normal function of the pulmonary valve at 2 years after surgery.Conclusion The autologous pericardial monocuspid valve patch can prevent pulmonary regurgitation,and though the long-term effect is not satisfying,it can reduce perioperation harm.