手术矫治右肺动脉起源于升主动脉的临床分析

The research in the operation of the anomalous right pulmonary artery originated from Ascending Aorta

目的:探讨一期手术矫治右侧肺动脉起源于升主动脉的手术指征、方法,并对2005年前后手术效果进行比较。方法:1993年1月至2011年7月,一期矫治右侧肺动脉起源于升主动脉15例,年龄5个月～14岁,中位数年龄3.0(2.0,7.3)岁,体质量5～37 kg,中位数体质量11.5(9.5,21.8)kg,2005年前8例,2005年后7例。术前均行超声心动图检查,2005年前漏诊3例。全组合并动脉导管未闭10例,室间隔缺损3例,主肺动脉间隔缺损2例。全部手术在静吸复合麻醉体外循环下完成根治手术。2005年前在深低温低流量下人工材料连接6例,其中同种异体血管5例,Gore-Tex血管1例,自体肺动脉直接连接2例;2005年后在中低温常流量下自体肺动脉直接连接7例,同期矫治心脏合并畸形。结果:手术死亡2例,均在2005年前死于术后肺部感染所致败血症。均在2005年前,2005年后无死亡。2005年后体外循环转机、阻断时间,术后呼吸机使用、ICU停留及住院时间明显缩短。全组随访6～37个月,1例2005年前行Gore-Tex人工血管连接者右肺动脉流速240 cm/s,压差23 mmHg(1 mmHg=0.133 kPa),余无狭窄。结论:右肺动脉起源升主动脉手术效果良好;中低温常流量自体肺动脉直接连接术后效果明显改善;术后肺部感染为常见并发症;

Objective：To study the operation indications,surgery methods and postoperative effects of the anomalous right pulmonary artery originated from Ascending Aorta.Methods： Retrospective analysis 15 patients with anomalous right pulmonary originated from Ascending Aorta in AN ZHEN hospital from January 1993 to July 2011.The age 5 m-14（2.0-7.3）years old,weight 5-37 kg（9.5-21.8） kg.Complicate with PDA 10,VSD 3,APW 2 cases.All cases underwent operation under general anesthesia and CPB.8 cases under deep low temperature low flows 2005 years ago,artificial vascular connection 6 patients（allogeneic blood vessels deep hypothnia CPB sels in 5 patients,and Gore-Tex blood vessels in 1）,direct anastomosis 2 cases;7 cases directly connecte under moderate hypothmia CPB 2005 years after;Complicate deformity correction.Results： 2 cases died,all In 2005 years ago and died in the lung infection caused by sepsis,2005 years later without death.2005 years after The CPB blocking time,postoperative respiratory machine using time,ICU stay time and hospital time obviously reduced.Outpatient service were followed up for 6-37 months,1 case echocardiography right pulmonary artery flow 240 cm/s,pressure 23 mmhg（1 mmHg=0.133 kPa）.Conclusion： Postoperative effect well;As far as possible use directly anastomosis and patch widened;Postoperative lung infection is a common complication.