新生兒室間隔完整型肺動脈閉鎖 Hybrid 手術預后分析_Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

Authors：

王寧 , 劉大為 , 劉宇航 , 趙燁 , 高明磊 , 盧旭寧 , 朱全偉 ,  文平

大連醫科大學附屬大連市兒童醫院心外科（遼寧大連 ?116012）;

Corresponding?author：

文平, Email: 13504115999@163.com

Keywords：

新生兒; 室間隔完整型肺動脈閉鎖; Hybrid 手術; B-T 分流術

DOI：

10.7507/1007-4848.201801006

Video：

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目的探討室間隔完整型肺動脈閉鎖（pulmonary atresia with intact ventricular septum，PA/IVS）新生兒行 Hybrid 手術的預后。方法回顧性分析 2015 年 7 月至 2017 年 11 月我院行 Hybrid 手術（食管超聲引導下經胸切口右室流出道途徑球囊擴張肺動脈瓣聯合 BT 分流術） 9 例 PA/IVS 新生兒的臨床資料，其中男 6 例、女 3例，手術年齡23（17～29）d。結果 9 例新生兒手術順利，手術時間 112（95～147）min。1 例死于肺部嚴重感染，余 8 例均順利出院。8 例存活患兒機械通氣時間 31（22～47）h，住院時間 17（12～23）d，出院時 8 例平均血氧飽和度升至 87.5%，平均右室收縮壓降至 49 mm Hg，肺動脈瓣跨瓣壓降至 28（21～46）mm Hg。1 例術后發生短暫的室上性心動過速，5 例患兒因為術中失血給予了輸血，3 例患兒出現肺動脈瓣少量反流，1 例患兒出現肺動脈瓣中量反流，無 1 例患兒發生心臟穿孔、主肺動脈瘤或低心排血量綜合征。隨訪時間為 17.5（7～26）個月。5 例患兒已完成根治手術，3 例患兒等待行根治手術。結論相對傳統外科手術和經皮介入術，Hybrid 手術治療可作為一種安全有效的替代治療手段，對于條件合適的 PA/IVS 新生兒可獲得滿意的預后。

Citation： 王寧, 劉大為, 劉宇航, 趙燁, 高明磊, 盧旭寧, 朱全偉, 文平. 新生兒室間隔完整型肺動脈閉鎖 Hybrid 手術預后分析. Chinese Journal of Clinical Thoracic and Cardiovascular Surgery, 2018, 25(10): 910-913. doi: 10.7507/1007-4848.201801006 Copy

1.	滕云, 莊建, 陳寄梅, 等. Ⅰ 型肺動脈閉鎖姑息術和根治術的比較. 中國胸心血管外科臨床雜志, 2017, 24(1): 48-51.
2.	Li QZ, Cao H, Chen Q, et al. Balloon valvuloplasty through the right ventricle: another treatment of pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2013, 95(5): 1670-1674.
3.	馮梅, 凌云飛. 華西醫院成功為新生兒心臟病患兒實施雜交手術. 中國胸心血管外科臨床雜志, 2014, 21(4): 456-456.
4.	Schwartz MC, Glatz AC, Dori Y, et al. Outcomes and predictors of reintervention in patients with pulmonary atresia and intact ventricular septum treated with radiofrequency perforation and balloon pulmonary valvuloplasty. Pediatr Cardiol, 2014, 35(1): 22-29.
5.	陳忠建, 李芳, 翟波, 等. 動脈導管內支架治療新生兒室間隔完整型肺動脈閉鎖的療效分析. 中華實用兒科臨床雜志, 2016, 31(23): 1795-1798.
6.	Hu R, Zhang H, Dong W, et al. Transventricular valvotomy for pulmonary atresia with intact ventricular septum in neonates: a single-centre experience in mid-term follow-up. Eur J Cardiothorac Surg, 2015, 47(1): 168-172.
7.	Hata H, Sumitomo N, Ayusawa M, et al. Biventricular repair of pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle: a case report of a minimum intervention surgical approach. J Cardiothorac Surg, 2016, 11(1): 94.
8.	Alwi M, Budi RR, Mood MC, et al. Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young, 2013, 23(2): 197-202.
9.	Mallula K, Vaughn G, El-Said H, et al. Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv, 2015, 85(7): 1196-1202.
10.	Schneider AW, Blom NA, Bruggemans EF, et al. More than 25 years of experience in managing pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2014, 98(5): 1680-1686.
11.	李渝芬, 李俊杰, 石繼軍, 等. 新生兒危重肺動脈瓣狹窄及室間隔完整型肺動脈瓣閉鎖經導管介入治療的短中期隨訪. 中華兒科雜志, 2012, 50(12): 925-928.
12.	Rathgeber S, Auld B, Duncombe S, et al. Outcomes of radiofrequency perforation for pulmonary atresia and intact ventricular septum: A single-centre experience. Pediatr Cardiol, 2017, 38(1): 170-175.
13.	Zheng J, Gao B, Zhu Z, et al. Surgical results for pulmonary atresia with intact ventricular septum: a single-centre 15-year experience and medium-term follow-up. Eur J Cardiothorac Surg, 2016, 50(6): 1083-1088.
14.	陳綱, 吳琳, 劉芳, 等. 經右室肺動脈瓣成形術治療室間隔完整型肺動脈閉鎖的中期隨訪. 中華小兒外科雜志, 2016, 37(2): 85-90.
15.	謝靜, 孫錕. 室間隔完整型肺動脈閉鎖的診斷及介入治療發展. 上海交通大學學報, 2014, 34(5): 759-762.

1. 滕云, 莊建, 陳寄梅, 等. Ⅰ 型肺動脈閉鎖姑息術和根治術的比較. 中國胸心血管外科臨床雜志, 2017, 24(1): 48-51.
2. Li QZ, Cao H, Chen Q, et al. Balloon valvuloplasty through the right ventricle: another treatment of pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2013, 95(5): 1670-1674.
3. 馮梅, 凌云飛. 華西醫院成功為新生兒心臟病患兒實施雜交手術. 中國胸心血管外科臨床雜志, 2014, 21(4): 456-456.
4. Schwartz MC, Glatz AC, Dori Y, et al. Outcomes and predictors of reintervention in patients with pulmonary atresia and intact ventricular septum treated with radiofrequency perforation and balloon pulmonary valvuloplasty. Pediatr Cardiol, 2014, 35(1): 22-29.
5. 陳忠建, 李芳, 翟波, 等. 動脈導管內支架治療新生兒室間隔完整型肺動脈閉鎖的療效分析. 中華實用兒科臨床雜志, 2016, 31(23): 1795-1798.
6. Hu R, Zhang H, Dong W, et al. Transventricular valvotomy for pulmonary atresia with intact ventricular septum in neonates: a single-centre experience in mid-term follow-up. Eur J Cardiothorac Surg, 2015, 47(1): 168-172.
7. Hata H, Sumitomo N, Ayusawa M, et al. Biventricular repair of pulmonary atresia with intact ventricular septum and severely hypoplastic right ventricle: a case report of a minimum intervention surgical approach. J Cardiothorac Surg, 2016, 11(1): 94.
8. Alwi M, Budi RR, Mood MC, et al. Pulmonary atresia with intact septum: the use of Conquest Pro coronary guidewire for perforation of atretic valve and subsequent interventions. Cardiol Young, 2013, 23(2): 197-202.
9. Mallula K, Vaughn G, El-Said H, et al. Comparison of ductal stenting versus surgical shunts for palliation of patients with pulmonary atresia and intact ventricular septum. Catheter Cardiovasc Interv, 2015, 85(7): 1196-1202.
10. Schneider AW, Blom NA, Bruggemans EF, et al. More than 25 years of experience in managing pulmonary atresia with intact ventricular septum. Ann Thorac Surg, 2014, 98(5): 1680-1686.
11. 李渝芬, 李俊杰, 石繼軍, 等. 新生兒危重肺動脈瓣狹窄及室間隔完整型肺動脈瓣閉鎖經導管介入治療的短中期隨訪. 中華兒科雜志, 2012, 50(12): 925-928.
12. Rathgeber S, Auld B, Duncombe S, et al. Outcomes of radiofrequency perforation for pulmonary atresia and intact ventricular septum: A single-centre experience. Pediatr Cardiol, 2017, 38(1): 170-175.
13. Zheng J, Gao B, Zhu Z, et al. Surgical results for pulmonary atresia with intact ventricular septum: a single-centre 15-year experience and medium-term follow-up. Eur J Cardiothorac Surg, 2016, 50(6): 1083-1088.
14. 陳綱, 吳琳, 劉芳, 等. 經右室肺動脈瓣成形術治療室間隔完整型肺動脈閉鎖的中期隨訪. 中華小兒外科雜志, 2016, 37(2): 85-90.
15. 謝靜, 孫錕. 室間隔完整型肺動脈閉鎖的診斷及介入治療發展. 上海交通大學學報, 2014, 34(5): 759-762.

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Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

新生兒室間隔完整型肺動脈閉鎖 Hybrid 手術預后分析

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