本文選題：肺動(dòng)脈閉鎖 + 粗大體肺側(cè)枝��； 參考：《北京協(xié)和醫(yī)學(xué)院》2017年博士論文

【摘要】：目的:體肺分流術(shù)與右室肺動(dòng)脈連接術(shù)都是應(yīng)用于肺動(dòng)脈閉鎖患者的姑息手術(shù),兩種術(shù)式均通過重建肺動(dòng)脈內(nèi)的前向血流以期恢復(fù)發(fā)育不良的固有肺動(dòng)脈。但目前兩種術(shù)式在臨床中的應(yīng)用仍存有爭(zhēng)議,我們對(duì)分別接受兩種術(shù)式的患者進(jìn)行對(duì)比,擬判斷兩種術(shù)式差異,及對(duì)患者的不同影響。方法:回顧性分析2011年1月至2016年1月98例在我院接受姑息手術(shù)治療的患者,其中44例患者接受體肺分流手術(shù),54例患者接受右室肺動(dòng)脈連接術(shù),對(duì)其圍術(shù)期及遠(yuǎn)期臨床資料進(jìn)行對(duì)比。相較于右室肺動(dòng)脈連接術(shù)患者,體肺分流患者具有更小的術(shù)前肺動(dòng)脈指數(shù)(68.57±38.25 vs.112.62±61.63 mm2/m2,p0.01)。結(jié)果:與右室肺動(dòng)脈連接術(shù)患者相比較,體肺分流術(shù)患者具有更短的呼吸機(jī)輔助時(shí)間(26.73±27.20 vs.40.88±36.93 hours,p = 0.045),更短的 ICU 住院時(shí)間(3.6±3.9 vs.5.7±5.5 days,p = 0.033),以及更短的住院時(shí)間(9.9±3.9 vs.14.7±11.9,p = 0.014),遠(yuǎn)期累積根治率及累積生存率兩組患者無顯著差異。結(jié)論:體肺分流術(shù)可以在肺動(dòng)脈發(fā)育更差及體肺側(cè)枝更多的患者中應(yīng)用,而且體肺分流術(shù)患者較右室肺動(dòng)脈連接術(shù)患者實(shí)現(xiàn)了更好的術(shù)后臨床療效,并有效的保留了患者的肺動(dòng)脈瓣環(huán)結(jié)構(gòu)�？傮w而言,我們認(rèn)為體肺分流術(shù)可使肺動(dòng)脈閉鎖伴室間隔缺損合并粗大體肺側(cè)枝的患者獲益更多。目的:對(duì)比我院不同危險(xiǎn)度開窗與不開窗患者術(shù)后資料,以期探求開窗對(duì)于不同危險(xiǎn)度Fontan患者的作用,指導(dǎo)臨床決策。方法:回顧性研究我院自2004年1月至2013年6月183例行心外管道Fontan手術(shù)患者。根據(jù)以往研究公認(rèn)的危險(xiǎn)因素,將患者分為低危組(93例)和高危組(90例)并分別對(duì)比兩組開窗患者與不開窗患者的臨床資料。結(jié)果:兩組開窗與不開窗患者在術(shù)前及術(shù)中資料方面均沒有顯著統(tǒng)計(jì)學(xué)差異。兩組開窗患者的血氧飽和度均顯著低于不開窗患者(P0.01)。在高危組中,開窗患者的胸腔引流量(1153 ml vs.1739 ml,p=0.021)及胸腔引流時(shí)間(11.9 days vs.17.0 days,p=0.028)均低于不開窗患者,而低危組中開窗患者與不開窗患者在胸腔應(yīng)流量及胸腔引流時(shí)間方面無顯著統(tǒng)計(jì)學(xué)差異。兩組中開窗患者與不開窗患者在并發(fā)癥發(fā)生率及死亡率方面無顯著統(tǒng)計(jì)學(xué)差異(P0.05)。結(jié)論:盡管開窗導(dǎo)致患者較低的血氧飽和度,但高危組開窗患者具有更短的胸腔引流時(shí)間及胸腔引流量�？紤]到低危組開窗患者與不開窗患者相類似的術(shù)后早期結(jié)果,我們建議對(duì)高�；颊咝虚_窗治療。
[Abstract]:Objective: Body-pulmonary shunt and right ventricular pulmonary artery connection are palliative procedures for patients with pulmonary atresia. However, there is still controversy about the application of the two surgical methods in clinical practice. We compared the two surgical procedures to judge the difference of the two methods and their effects on the patients. Methods: from January 2011 to January 2016, 98 patients underwent palliative operation in our hospital. Among them, 44 patients received monopulmonary shunt surgery and 54 patients received right ventricular pulmonary artery connection (RVPA). The perioperative and long-term clinical data were compared. Compared with the patients with right ventricular pulmonary artery connection, the preoperative pulmonary artery index was 68.57 鹵38.25 vs.112.62 鹵61.63 mm / m ~ 2 / m ~ (2) P _ (0.01). Results: compared with the patients with right ventricular pulmonary artery connection, There was no significant difference in long-term cumulative radical cure rate and cumulative survival rate between the two groups. The patients had shorter ventilator assisted time (26.73 鹵27.20 鹵36.93 hours), shorter ICU hospitalization time (3.6 鹵3.9 vs.5.7 鹵5.5daysP = 0.033) and shorter hospitalization time (9.9 鹵3.9 vs.14.7 鹵11.9p = 0.014). Conclusion: Body-lung shunt can be used in patients with lower pulmonary artery development and more lateral branches of body and lung, and better clinical effect is achieved in patients with pulmonary shunt than those with right ventricular pulmonary artery connection (RVPA). The pulmonary annulus structure of the patient was effectively preserved. In general, we believe that the pulmonary artery atresia with ventricular septal defect with bulky lateral branch of the lung can benefit more. Objective: to compare the postoperative data of patients with different risk of fenestration and non-fenestration in order to explore the effect of fenestration on patients with different risk of Fontan and to guide the clinical decision. Methods: from January 2004 to June 2013, 183 Fontan patients underwent extracardiac catheterization in our hospital. According to the accepted risk factors, the patients were divided into low risk group (93 cases) and high risk group (90 cases). Results: there was no significant difference in preoperative and intraoperative data between the two groups. The blood oxygen saturation of the two groups was significantly lower than that of the non-fenestration patients (P 0.01). In the high risk group, the thoracic drainage volume of 1153ml / ml vs.1739 / ml p0. 021) and the time of thoracic drainage were lower in the patients with fenestration than in the patients without fenestration, and the time of thoracic drainage was 11. 9 days vs.17.0 / d. 028). In the low risk group, there was no significant difference between the patients with fenestration and the patients without fenestration in the pleural volume and the time of thoracic drainage. There was no significant difference in the incidence of complications and mortality between patients with and without fenestration between the two groups (P 0.05). Conclusion: although fenestration leads to lower blood oxygen saturation, the patients in high risk group have shorter thoracic drainage time and thoracic drainage volume. Considering the early postoperative outcomes of patients with low risk and non-fenestration, we suggest that high risk patients should be treated with fenestration.
【學(xué)位授予單位】：北京協(xié)和醫(yī)學(xué)院
【學(xué)位級(jí)別】：博士
【學(xué)位授予年份】：2017
【分類號(hào)】：R726.5

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