主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用

Application of side-to-side aorto-Gore-Tex technique in systemic pulmonary shunting

目的探讨主动脉与人工血管侧侧吻合技术在体肺动脉分流术中的应用。方法2010年4月至2011年6月，44例紫绀型先天性心脏病患儿行主动脉与人工血管侧侧吻合的体肺动脉分流术，其中升主动脉-主肺动脉38例，升主动脉-左肺动脉4例，升主动脉-右肺动脉2例。男、女各22例；〈1岁23例，1～3岁14例，〉3岁7例；体质量（9．24-3．6）kg。肺动脉闭锁32例（3例室间隔完整，29例伴室间隔缺损），法洛四联症10例，右室双出口合并肺动脉狭窄和矫正性大动脉转位并肺动脉狭窄各1例。术后定期随访。结果全组无手术死亡。2例出现早期狭窄，1例因早期分流堵塞再次行中心分流术，1例分流过多。术后经皮血氧饱和度由0．67±0．10增加至0．81±0．07。术后动脉压增加0～25mmHg（1mmHg=0．133kPa），中位值6．5mmHg。所有患儿随访12～23个月。2例出院后第1、3个月因误吸死亡；2例人工血管狭窄；2例人工血管闭塞，其中1例术后14个月再次行体肺动脉分流术；7例肺动脉发育良好者行进-步手术治疗，其中4例行根治手术，3例行Glenn手术。余患儿经皮血氧饱和度0．82±0．05，超声心动图示分流血管通畅，血流束与人工血管口径-致。结论主动脉与人工血管侧侧吻合技术的体肺动脉分流术操作简单，安全性高，人工血管堵塞率低，可以推广应用。

Objective To evaluate the technique of side-to-side aorto-Gore-Tex systemic pulmonary shunting. Methods Between April 2010 and June 2011,44 patients with cyanotic congenital heart disease underwent side-to-side aorto-Gore-Tex systemic pulmonary shunts, central shunt in 38 cases, aorto-left pulmonary artery in 4 and aorto-right pulmonary artery in 2. Less than 1 year old was 23 cases, 1-3 years was 14 cases, 7 cases over 3 years old. Median weight at surgery was 9.2 kg （3.5 to 21.0 kg）. 10 cases were tetralogy of Fallot , 32 cases were pulmonary atresia, and others in 2. Shunt sizes ranged from 4 to 6 ram. Results No patient died during hospital stay. Only one shunt needed early redo. Two shunts early stenosis and one shunt overflow. The arterial oxygen saturation significant improved, from preoperation 0.67± 0.10 to postoperation 0.81 ± 0.07. All patients were follow-up 12 to 23months, median follow-up of 18 months , Two patients died of aspiration. Two pa- tients had stenosis and two patients had blockage of Gore-Tex artificial graft respectively. Seven patients got satisfied pulmonary dimeter and further operations. Four of them underwent correction and the other three patients underwent Glenn operation. The arterial oxygen saturation of other patients was good. The shunts were patency. Conclusion Side-to-side aorto-Gore-Tex sys- temic pulmonary shunting was simple and reliable. Side-to-side aorto-Gore-Tex anastomosis seems to reliably warrant shunt pa- teney and harmonious growth of pulmonary arteries.