带瓣自体心包补片在法洛四联症矫治术中的临床应用

Clinical research on autologous valved pericardial patch in the correction surgery of tetralogy of fallot

目的探讨经蒸馏水处理的活性自体心包补片在法洛四联症右心室流出道重建术中的应用,并对其临床效果进行评价。方法选取进行法洛四联症一期矫治手术的患者125例,术中均采用经蒸馏水处理的活性自体心包补片进行右心室流出道的重建。其中,39例采用单纯自体心包补片,86例采用带瓣自体心包补片。对两组患者进行随访,比较肺动脉瓣的返流程度及活动度变化情况。结果单纯补片组术后平均随访时间为(63±8)个月,带瓣补片组术后平均随访时间为(55±7)个月;两组患者的年龄、体表面积、心率、肺动脉直径、体外循环时间、术后胸引液量差异均无统计学意义;随访期内单纯补片组术后肺动脉瓣返流加重程度、瓣膜活动度降低程度明显高于带瓣补片组。结论用经蒸馏水处理的活性带瓣自体心包补片进行右心室流出道重建,有助于降低法洛四联症术后肺动脉瓣的返流及减缓瓣膜增厚硬化程度,在临床中取得了良好的中期效果。

Objective To investigate the activity of autologous pericardial patch treated by distilled water in right＆amp;nbsp;ventricular outflow tract reconstruction of tetralogy of fallot,and to evaluate its clinical effect. Methods The study used 125 patients who had applied correction surgery of tetralogy of fallot and autologous pericardial patch treated by distilled water in the right ventricular outflow reconstruction. 39 cases used fresh autologous pericardial patches,and 86 cases used autologous valved pericardial patch. The degree of insufficiency and activity of the pulmonary valve were compared. Results The mean follow-up time was （ 63 ＆#177; 8 ） months in fresh autologous pericardial patches group, while （55 ＆#177; 7） months in valved patch group. No significant difference was found in age, body surface area, heart rate, pulmonary artery diameter, cardiopulmonary bypass time and priming volume postoperative between the two groups. The exacerbations of pulmonary valve insufficiency and activity in fresh autologous pericardial patches group were significantly higher than in valved patch group. Conclusion Autologous pericardial patch treated by distilled water was beneficial in right ventricular outflow tract reconstruction of tetralogy of fallot. It reduced pulmo-nary valve insufficiency and sclerosis after the correction surgery and showed good mid-term clinical results .