介入治疗在法洛四联症根治术后残余畸形中的应用

Interventional treatment for residual malformations of tetralogy of Fallot after radical surgery

目的探讨介入治疗在法洛四联症(TOF)根治术后残余畸形中的应用效果。方法回顾性选取2010年1月至2018年6月首都医科大学附属北京安贞医院收治的TOF根治术后行介入治疗患者26例,包括行经皮体肺侧支血管封堵术6例,经皮肺动脉(瓣)球囊扩张术14例,经皮肺动脉支架置入术6例。观察术后即刻疗效,并于术后1、3、6、12个月随访治疗后跨肺动脉瓣或狭窄近远端压差及肺动脉发育情况,评价介入手术疗效。结果全组患者均顺利进行介入治疗。6例行经皮体肺侧支血管封堵术患者术后肺出血好转,顺利拔除气管插管。14例行经皮肺动脉(瓣)球囊扩张术患者术后即刻跨肺动脉瓣及狭窄近、远端压差及右心室收缩压较术前均明显降低[(37±16)mmHg(1 mmHg=0.133 k Pa)比(79±20)mmHg、(57±8)mmHg比(95±23)mmHg],术后12个月患者跨肺动脉瓣及狭窄近、远端压差和主肺动脉内径及Nakata指数较术前均明显改善(均P<0.05)。6例经皮肺动脉支架置入术患者术后即刻跨狭窄近、远端压差和右心室收缩压较术前均明显降低[(35±17)mmHg比(62±12)mmHg、(53±13)mmHg比(74±17)mmHg],术后12个月患者跨狭窄近、远端压差和肺动脉内径、Nakata指数均较术前明显改善(均P<0.05)。结论内科介入治疗TOF根治术后残余畸形,可明显改善患者预后,提高患者生活质量。

Objective To investigate the clinical effect of interventional treatment on residual malformations of tetralogy of Fallot(TOF)after radical surgery.Methods A retrospective study was conducted on26 patients who underwent interventional procedure following TOF radical surgery in Beijing Anzhen Hospital,Capital Medical University from January 2010 to June 2018,including 6 cases of percutaneous pulmonary collateral artery occlusion,14 cases of percutaneous pulmonary artery(valve)balloon dilatation and 6 cases of percutaneous pulmonary artery stent implantation.Immediate effect was observed after procedure.Pressure difference across pulmonary valve/stenosis and pulmonary artery development were observed at 1,3,6,12 months after interventional treatment.Results Interventional operation was successfully performed in all patients.Six patients who underwent percutaneous pulmonary collateral artery occlusion recovered well;pulmonary hemorrhage was alleviated and tracheal intubation was removed after operation.In 14 patients who underwent percutaneous balloon pulmonary valvuloplasty,pressure difference across pulmonary valve/stenosis and right ventricular systolic pressure were significantly reduced after operation[(37±16)mmHg vs(79±20)mmHg,(57±8)mmHg vs(95±23)mmHg];at 12 months after operation,pressure difference,main pulmonary artery diameter and Nakata index were significantly improved(all P<0.05).In 6 patients who underwent percutaneous pulmonary artery stenting,pressure difference across stenosis and right ventricular systolic pressure significantly decreased after operation[(35±17)mmHg vs(62±12)mmHg,(53±13)mmHg vs(74±17)mmHg];pressure difference,pulmonary artery diameter and Nakata index at 12 months after operation were significantly improved(all P<0.05).Conclusion Interventional therapy treating residual malformations after TOF radical surgery can effectively improve the prognosis and quality of life.