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目的 回顾和总结小儿永存动脉干右室流出道重建治疗经验。
方法 我院从2000年1月～2007年12月共收PTA先心病行根治手术治疗43例，其中Ⅰ型、Ⅱ型、Ⅲ型PTA分别为26例、11例和6例。男21例，女17例。年龄1.5月～3.8岁（平均0.9岁±1.7）, 体重3.2 ～23 kg（平均7.5 kg±3.8）。18例PTA的肺动脉直接下拖至右室流出道切口上缘相吻合，前壁再用心包补片扩大；6例用Homograft管道、14例用牛颈静脉管道连接远端肺动脉和右心室，重建右室流出道，另外3例Ⅱ型PTA者，肺动脉后壁用左心耳壁与右室流出道上缘做吻合，前壁再用心包补片扩大。
结果 所有病人均存活，术后5 例患儿表现为右心功能不全，另有2 例右肺动脉（RPA）阶差达5.0～6.3Kpa，术后17天恢复至4.7Kpa以下。左心室流出道阶差均小于2.7Kpa。残余VSD2mm1例，乳糜胸1例。5例患儿由于肺血管阻力高，吸一氧化氮（NO）治疗一周左右后好转。随访3月～3年有2 例患儿RPA残余压差在3.2～3.9Kpa，均无明显右心室或左心室流出道梗阻。结论 肺总动脉后壁直接与右室切口作吻合来重建PTA的右室流出道，早期和远期效果良好；牛颈静脉的带瓣管道，解决了小尺寸同种带瓣管道来源不足的问题，操作简便。
[关键词] 小儿永存动脉干；右室流出道重建； 复杂型 The techniques of right ventricular outflow tract reconstruction for Truncus Arteriosus repair in children Jing-Hao Zheng, Zhi-Wei Xu, Jin-Fen Liu, Zhao-kang Su, Wen-Xiang Ding Department of Cardiothoracic Surgery, Shanghai Children’s Medical Center, Affiliated with Medical College of Shanghai Jiaotong University, Shanghai 200127 【Abstract】 Objective: To evaluate the surgical effect of right ventricular outflow tract reconstruction for Persistent Truncus Arteriosus(PTA) repair in children. Methods: There were 43 cases of PTA in babyhood and infant which were operated in our hospital from January 2000 to December 2007. The number for the type Ⅰ,type Ⅱ and type Ⅲ is 26,11 and 6 cases respectively. They aged from1.5 months to 3.8 years (0.9 years ±1.7）and weighted from 3.2 Kg to 23 Kg(7.5±3.8）.The wall of pulmonary artery was anastomosed to brim of incision of the right ventricular outflow tract with pericardiam to enlarge the former wall in 18 cases. The homograft in 6 cases and cattle jugular vein graft in 14 cases were used to construct the right ventricular outflow tract. In the other 3 cases ,the left atria wall was connected between the wall of pulmonary artery and the right ventricular outflow tract. Results: All the patients were alive. The right ventricular disfunction was appeared in 5 cases. There was pressure gradient in right pulmonary artery about 5.0～6.3Kpa in the other 2 cases and was reduced below 4.7Kpa after 17 days. The pressure gradient in the left ventricular outflow tract was below 2.7Kpa . The NO was used for one week in 5 cases because of the high pulomnbary artery pressure. With follow up of 3~36 months, there was 3.2～3.9Kpa of residual pressure gradient in right pulmonary artery in 2 cases and all the patients appeared no right and left ventricular outflow tract obstruction. Conculsions: The results for the early and mid term follow-up seemed satisfactory with method of the wall of pulmonary artery was directly anastomosed to brim of incision of the right ventricular outflow tract. The cattle jugular vein graft was convenient and has different sizes which fulfill the shortage of source. 【Key words】 Right ventricular outflow tract; reconstruction; Truncus Arteriosus |
