^(99)Tc^m-MAA对完全旷置右心手术后肺血分布的定量研究

Study of pulmonary blood distribution with ^(99)Tc^m-MAA in patients undergoing extracardiac total cavopulmonary connection

目的 探讨完全旷置右心手术对肺血分布的影响。方法 应用99Tcm 大颗粒聚合白蛋白肺灌注显像对 14例改良心外管道全腔静脉肺动脉连接术 (ETCPC)患者手术前后的肺血分布情况进行定量研究。结果 术后右肺与左肺血流灌注量比值为 1 16± 0 16 ,高于术前的 0 96± 0 11(P <0 0 5 )。术后肺野上段血流灌注量明显降低 ,与术前相比 ,差异有显著性 (P <0 0 5 ) ,下段血流灌注量增加 (P <0 0 1) ,其上 /下段比值为 0 2 2± 0 0 8,低于术前的 0 44± 0 0 9(P <0 0 1)。结论 改进的手术方法仍可保持右肺的相对优势灌注血流。

Objective To study the effects of extracardiac total cavopulmonary connection (ETCPC) on pulmonary blood distribution. Methods Combinate a bidirectional cavopulmonary anastomosis with a Gore-Tex extracardiac conduit interposition between the inferior vena cava and the main pulmonary artery, and the changes of pulmonary blood distribution were evaluated with SPECT in all the patients who survived the surgery. Results The postoperative fraction of right lung/left lung blood perfusion was higher than the preoperative date (P<0.05). And the upper/lower lobe perfusion was 0.22±0.08, decreased significantly in all postoperative patients (P<0.05). Conclusions This modified vascular anastomosis also can offer a relatively dominant blood perfusion in the right lung. The decreased upper/lower lobe perfusion ratio in the postoperative period may be of clinical importance in the complication of pulmonary arteriovenous fistula and the reduction in the tolerance of physical exercise.