肺动脉束带术在治疗复杂型先天性心脏病中的临床应用

The clinical application of pulmonary artery banding in treating complicated congenital heart diseases

目的 探讨肺动脉束带术 (PAB)在治疗复杂型先天性心脏病中的应用价值。方法 1997年 5月至 1998年11月 ,在我科住院的 8例患儿 ,年龄 4个月～ 8岁 ,平均 (3 3± 2 5 )岁 ,体重 4 5～ 17kg ,平均 (10 8± 3 8)kg ,经心导管检查及造影诊断为复杂型先天性心脏病伴肺动脉高压且无一期根治手术指征。 6例施行体外循环手术 ,其中 5例先行房间隔造口术 ,3例合并动脉导管未闭者予以结扎或缝扎 ;再按Trusler的方法施行PAB ;2例在非体外循环下行PAB。结果术后肺动脉压力 32～ 40mmHg ,动脉血氧饱和度 (SaO2 )为85 %～ 95 %。随访 2～ 2 0个月 ,肺炎及充血性心力衰竭明显减少或消失 ,SaO2 维持在 80 %～ 97% ,超声心动图检测跨肺动脉束带处压力阶差为 44～ 6 7 6mmHg。无手术死亡及严重并发症。结论 PAB可作为部分复杂型先天性心脏病的过渡型姑息手术 ,为以后的二期手术创造条件 ;亦可作为较大龄高危患儿的终结性姑息手术 ,改善生活质量。

Objective To study the results and current indications of pulmonary artery banding in treating complicated congenital heart diseases. Method 8 child ren with congenital heart defects characterized by excessive pulmonary blood flow underwent pulmonary artery banding at Guangdong Provincial Hospital from May 1997 through November 1998. The patients aged 4 months to 8 years[mean, (3.3±2.5) years] and weighing 4.5 to 17.0 kg[mean, (10.8±3.8)kg]. All Patients underwent diagnostic cardiac catheterization, angiography and echocardiography. Pulmonary artery banding was performed in 8 cases, under cardiopulmonary bypass in 6 cases. Atrial septectomy was performed in 5 cases and ductus ligation in 3 cases. We estimated required band circumference according to Truslers method. Results No early death and severe complication. The pulmonary artery pressure was 32 to 40 mmHg (systolic) and artery satuation was 85%～95% postoperatively. Follow up 2 to 20 months, congestive heart failure decreased obviously or disappeared. The artery satuation was 80%～97% and pressure gradient acuoss the band was 44 to 67.6 mmHg by echocardiography. Conclusions Pulmonary artery banding remains an effective means of achieving satisfactory palliation in infants with congenital heart diseases, reduces pulmonary artery pressure and improves clinical symptoms. It could be the last Palliative operation in older children with some complex anomalies.