肺动脉闭锁的外科治疗22例

Surgical treatment of twenty-two cases with pulmonary atresia

目的 总结肺动脉闭锁 (包括室间隔完整和合并室间隔缺损两大类 )的外科治疗效果 .方法 我院 1995 - 0 6 /2 0 0 2 - 0 3对 2 2例肺动脉闭锁患儿进行了外科治疗 ,男 15例 ,女 7例 ,年龄 13d～ 11岁 .其中室间隔完整的肺动脉闭锁 5例 ,按照 Bull和 de L eval的分型 , 型 2例 , 型 2例 , 型 1例 ,Z值 1例为 - 1.2 ,2例在 - 1.5～ - 3之间 ,2例为 <- 3.5例室间隔完整的肺动脉闭锁中有 1例施行了跨瓣补片加宽右心室流出道、闭合房缺和结扎动脉导管手术 ,1例进行了肺动脉瓣切开手术 ,1例进行了肺动脉瓣切开和主动脉 -肺动脉分流术 ,2例进行了主动脉 -肺动脉分流术和结扎未闭动脉导管 . 17例合并室间隔缺损肺动脉闭锁患者均应用同种带瓣管道施行了矫治手术 .结果 手术死亡 2例 .并发症有胸腔积液 7例 ,心包腔积液 1例 ,均经治疗痊愈出院 .结论 1通过测得三尖瓣口的直径的校正值 (Z值 )来评价手术适应证 ,对室间隔完整的肺动脉闭锁手术治疗有较好的指导意义 。

AIM To sum up surgical treatment results of pulmonary atresia (PA) including PA with intact ventricular septum and PA with VSD. METHODS Twenty two cases of PA underwent surgical procedure from June 1995 to May 2002. They were 15 males and 7 females. The age range was 13 days～11 years old. In the 5 cases of PA with intact ventricular septum there were 2 of type Ⅰ, 2 of type Ⅱ and 1 of type Ⅲ. Z value was -1.2 in 1 case, -1.5～-3 in 2 cases and ≤-3 in 2 cases. The procedure of widenning the right ventricular outflow tract with transannular patch, closing ASD and ligaturing PDA was performed in one case, pulmonary valvotomy in one case, pulmonary valvotomy and aorte pulmonary shunt in 2 cases of the 5 cases of PA with intact ventricular septum. The corrected operation with valved homograft were done in 17 cases of PA with VSD. RESULTS Except for two deaths in perioperative period, all patients got good operative results. CONCLUSION ① Z value is a good guiding value for estimating the operative indications of PA with intact ventricular septum. ② It is very important to improved operative result that the operative indications be mastered preoperatively in PA with VSD.