【摘要】：目的：評(píng)價(jià)Hybrid手術(shù)治療法洛四聯(lián)癥(TOF)合并巨大體肺側(cè)枝循環(huán)(MAPCAs)的臨床效果及其臨床應(yīng)用價(jià)值。 方法：回顧分析2009年12月至2013年8月期間我院11例復(fù)雜型法洛四聯(lián)癥合并巨大體肺側(cè)枝循環(huán)的病例,均采用先行介入封堵,后行根治性手術(shù)的聯(lián)合治療。 結(jié)果：共發(fā)現(xiàn)體肺側(cè)支動(dòng)脈18支,側(cè)支直徑2～7mm,平均4.3±1.5mm。對(duì)其中15支巨大體肺側(cè)支進(jìn)行了成功封堵,共用彈簧栓43枚。對(duì)于其中1支遠(yuǎn)端狹窄、2支細(xì)小("f2mm)的側(cè)支血管不予封堵處理。介入封堵過(guò)程順利,僅1例患者出現(xiàn)急性缺氧發(fā)作,急診開(kāi)胸行外科根治手術(shù),其余10例均常規(guī)開(kāi)胸手術(shù)。 手術(shù)過(guò)程順利。升主動(dòng)脈阻斷時(shí)間(77.33士20.58)m in,體外循環(huán)時(shí)間(128.66±30.55)min,呼吸機(jī)輔助時(shí)間2-4天,ICU時(shí)間3-5天。1例術(shù)后當(dāng)天行剖胸探查止血術(shù)；2例出現(xiàn)胸腔積液；11例均未出現(xiàn)肺水腫、灌注肺、低心排等并發(fā)癥,無(wú)1例行補(bǔ)救性封堵術(shù)。術(shù)前紫紺的患者術(shù)后均明顯減輕,缺氧癥狀明顯改善,11例患者均于術(shù)后8-10天康復(fù)出院。 11例患者隨訪3-24個(gè)月,復(fù)查心臟CT提示側(cè)枝封堵情況良好,其中1例患者心功能Ⅱ-Ⅲ級(jí),其余患者心功能均在Ⅰ-Ⅱ級(jí)以上。 結(jié)論：Hybrid手術(shù)治療法洛四聯(lián)癥合并巨大體肺側(cè)枝循環(huán)的是安全穩(wěn)定的,并具有出血少、損傷小、手術(shù)時(shí)間短、術(shù)后恢復(fù)快、并發(fā)癥少等優(yōu)點(diǎn),臨床應(yīng)用價(jià)值巨大,Hybrid手術(shù)在先天性心臟病的治療中有非常廣闊的前景。
[Abstract]:Objective: to evaluate the clinical effect and clinical value of Hybrid in the treatment of tetralogy of Fallot (TOF) with giant pulmonary collateral circulation (MAPCAs). Methods: 11 cases of complex tetralogy of Fallot with giant pulmonary collateral circulation were retrospectively analyzed from December 2009 to August 2013. All patients were treated with interventional closure and radical operation. Results: a total of 18 pulmonary arteries were found, with a diameter of 2mm and an average of 4.3 鹵1.5mm. Fifteen of them were successfully occluded with 43 spring plugs. For one of the distal stenosis, 2 small ("f2mm) collateral vessels were not occluded." The procedure of interventional closure was smooth, only one patient had acute anoxic attack, and the other 10 patients had routine thoracotomy. The operation went smoothly. The ascending aorta occlusion time (77.33 鹵20.58) m in,) was (128.66 鹵30.55) min, ventilator assisted time 2-4 days, ICU time 3-5 days. Pleural effusion was found in 2 cases, pulmonary edema, pulmonary perfusion and low cardiac output were not found in 11 cases. All patients with cyanosis were relieved and anoxic symptoms were improved. 11 patients were discharged from hospital from 8 to 10 days after operation. 11 patients were followed up for 3-24 months. The results of cardiac CT showed that the occlusion of collateral branches was good. One patient had cardiac function grade 鈪，

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