探讨初次手术治疗室间隔完整的Ⅰ、Ⅱ型肺动脉闭锁(PA/IVS)的效果。
50例I型PA/IVS儿童和50例II型PA/IVS儿童接受初次手术。将I型儿童分为A组(n=25)和B组(n=25)。A组接受BT分流联合PDA结扎及肺动脉瓣球囊扩张术,B组行BT分流联合PDA结扎和肺动脉瓣切开。将II型儿童分为C组(n=25)和D组(n=25)。C组接受BT分流联合PDA结扎,右室流出道(RVOT)切口和经环形补片。D组行BT分流联合PDA结扎,RVOT切口,经环补片和人工肺动脉瓣植入术。机械通气时间的差异,ICU住院时间,死亡率,三尖瓣Z值,三尖瓣反流,氧饱和度,肺反流,麦戈恩比率,肺动脉跨瓣压,比较A组和B组的生存率,分别在C组和D组之间。
C组呼吸机辅助时间和ICU住院时间长于D组(80.96±8.42hvs.65.16±4.85h,P=0.045;222.00±11.72hvs.162.48±7.91h,P=0.048)。术后3、6、12、24和36个月,A组肺动脉跨瓣压明显高于B组(64.86±4.13mmHgvs.53.04±5.64mmHg,P=0.045;69.47±1.93mmHgvs.55.95±4.04mmHg,P=0.005;80.16±3.76mmHgvs.73.24±2.34mmHg,P=0.035;62.95±5.64mmHgvs.48.47±7.44mmHg,P=0.04;53.69±4.89vs.45.77±3.26,P=0.02)。此外,术后3个月和24个月,B组三尖瓣Z值明显大于A组(-(1.37±0.04)vs.-(1.43±0.06),P=0.03;-(0.41±0.06)vs.-(0.51±0.11),P=0.02)。
BT分流联合PDA结扎和肺动脉瓣切开的效果优于BT分流联合PDA结扎和球囊扩张肺动脉瓣的效果。以及BT分流联合PDA结扎的效果,RVOT切口,经环补片和人工肺动脉瓣植入术优于BT分流联合PDA结扎,RVOT切口和经环补片。
To explore the effect of initial surgery for type I and II pulmonary atresia with intact ventricular septum (PA/IVS).
50 children with type I PA/IVS and 50 with type II PA/IVS who had undergone initial surgery were enrolled. Children with Type I were divided into groups A (n = 25) and B (n = 25). Group A had received BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, whereas group B had undergone BT shunt combined with PDA ligation and pulmonary valve incision. Children with type II were divided into groups C (n = 25) and D (n = 25). Group C had received BT shunt combined with PDA ligation, right ventricular outflow tract (RVOT) incision and transannular patch. Group D had undergone BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation. The differences in mechanical ventilation time, length of ICU stay, mortality rate, tricuspid Z value, tricuspid regurgitation, oxygen saturation, pulmonary regurgitation, McGoon ratio, pulmonary artery transvalvular pressure, survival rate were compared between groups A and B, between groups C and D respectively.
The ventilator assistance time and length of ICU stay were greater in group C than in group D (80.96 ± 8.42 h vs. 65.16 ± 4.85 h, P = 0.045; 222.00 ± 11.72 h vs. 162.48 ± 7.91 h, P = 0.048). The pulmonary artery transvalvular pressure was significantly higher in group A than in group B at 3, 6, 12, 24 and 36 months after surgery (64.86 ± 4.13 mmHg vs. 53.04 ± 5.64 mmHg, P = 0.045; 69.47 ± 1.93 mmHg vs. 55.95 ± 4.04 mmHg, P = 0.005; 80.16 ± 3.76 mmHg vs. 73.24 ± 2.34 mmHg, P = 0.035; 62.95 ± 5.64 mmHg vs. 48.47 ± 7.44 mmHg, P = 0.04; 53.69 ± 4.89 vs. 45.77 ± 3.26, P = 0.02). Furthermore, the tricuspid Z value was significantly greater in group B than in group A at 3 and 24 months after surgery (- (1.37 ± 0.04) vs. - (1.43 ± 0.06), P = 0.03; - (0.41 ± 0.06) vs. - (0.51 ± 0.11), P = 0.02).
The effect of BT shunt combined with PDA ligation and pulmonary valve incision is superior to BT shunt combined with PDA ligation and balloon dilatation of pulmonary valve, and the effect of BT shunt combined with PDA ligation, RVOT incision, transannular patch and artificial pulmonary valve implantation is superior to BT shunt combined with PDA ligation, RVOT incision and transannular patch.