动脉导管内支架治疗新生儿室间隔完整型肺动脉闭锁的疗效分析

Efficacy analysis on arterial catheter stents for pulmonary atresia with intact ventricular septum in newborns

目的比较动脉导管内支架置入术与传统的体肺分流术治疗新生儿室间隔完整型肺动脉闭锁的疗效。方法选取2005年12月至2015年12月郑州市儿童医院收治的室间隔完整型肺动脉闭锁患儿26例，年龄3～23（8.20±4.80） d，体质量2.80～3.88 （3.41±0.27） kg。患儿均合并动脉导管未闭及房间隔缺损或卵圆孔未闭，均伴有肺动脉发育不良。术前患者末梢血氧饱和度维持61%～75%，平均67%。其中行动脉导管内支架置入术12例，行体肺分流术（包括改良B-T分流和中央分流）＋动脉导管结扎术14例。观察患儿术后的血氧饱和度，检查超声心动图和正侧位胸片，评估支架和管道的血流情况，术后1、3、6和12个月进行随访。结果术中12例患儿均顺利置入支架。传统体肺分流术组术后末梢血氧饱和度为（82.73±5.59）%，与动脉导管内支架组[（86.18±3.19）%]比较差异有统计学意义（t＝10.71，P〈0.05）。体肺分流术组死亡2例，1例术后心力衰竭死亡，1例合并肺部感染，呼吸衰竭死亡；动脉导管内支架组术后1例室上性心动过速，药物干预后恢复。术后1、3、6和12个月进行随访，体肺分流术组行改良B-T分流的1例由于管道血流缓慢，分流量较少，血氧饱和度为69%，再次行中央分流。动脉导管内支架组1例患儿因术后2个月末梢血氧饱和度下降而再次行支架球囊扩张术，术后经皮氧饱和度改善。动脉导管内支架组无死亡病例。结论动脉导管内支架置入术可作为室间隔完整型肺动脉闭锁一期手术首选治疗方法，减少了传统开胸体肺分流术的创伤大、并发症多、恢复慢等缺点，方法可行，效果良好。

ObjectiveTo compare the efficacy of arterial stenting with that of traditional B-T shunt for neonatal pulmonary atresia with intact ventricular septum.MethodsTwenty-six cases of neonatal pulmonary atresia with intact ventricular septum were treated at Children′s Hospital of Zhengzhou from December 2005 to December 2015, aged 3 to 23 days[（8.20±4.80） days], and weighted 2.80-3.88 （3.41±0.27） kg.Accompanied with pulmonary hypoplasia, all these patients were combined with PDA and ASD or PFO.Before operation, the peripheral oxygen saturation was kept in 61%-75%, averaged at 67%.Among them, 12 cases underwent arterial catheter stenting, and 14 cases received B-T shunt （including modified B-T shunt and central shunt） ductus ligation.After operation, the oxygen saturation in these children was observed, and they were examined by echocardiography and true lateral chest X-ray, blood flow situations in stents and shunts were assessed, and follow-up examinations were conducted in 1, 3, 6 and 12 months postoperatively.ResultsStents were successfully inserted into these 12 cases.After traditional pulmonary shunt, patients′ peripheral oxygen saturation was （82.73±5.59）%, compared with that of patients after arterial catheter sten-ting （86.18±3.19）%, there was significant difference（t=10.71, P〈0.05）. In pulmonary shunt group, 2 cases died, 1 case died of postoperative heart failure, and the other case was complicated with pulmonary infection and died of respiratory failure; in catheter stent group, 1 case was complicated with postoperative supraventricular tachycardia and recovered after drug intervention.For the follow-up examinations 1, 3, 6 and 12 months after the operation, 1 case of B-T shunt in pulmonary shunt group was improved by central shunt due to slow blood flow, less shunt volume, and oxygen saturation decreased to 69%.For the catheter stent group, 1 case was improved by stent balloon dilatation due to declined peripheral oxygen saturation 2 months postoperatively, and after the operation, transcutaneous oxygen saturation was improved.No patients died in the catheter stent group.ConclusionsIn traditional B-T shunts, the operation is extensive, and complications are common, and the recovery turns slowly.Arterial catheter stenting can be used as the preferred method of treatment for one-stage surgical pulmonary atresia with intact ventricular septum to reduce the weakness feasibly and effectively.