卢蓉,尚小珂,沈群山,张刚成

• 1:武汉亚洲心脏病医院心外科先心病中心

摘要(Abstract)：

目的总结法洛四联症(TOF)合并体肺侧支血管的患者采取一站式内外科镶嵌治疗(Hybrid)的临床效果。方法入选2008年1月至2013年6月于武汉亚洲心脏病医院就诊的79例TOF合并体肺侧支患者,平均年龄(5.4±3.9)岁,平均体重(18.2±5.7)kg,术前均经心脏彩超检查明确诊断,全组患者在术前行64排心脏增强CT检查,肺血管无不良发育,McGoon指数为1.7±0.6,Nakata指数为176.7±7.3。76例初步筛查有体肺侧支血管,术前均行心血管造影检查。3例术前漏诊,术后行心血管造影确诊。结果本研究患者中死亡4例,死亡率5.1%。1例死于肺部感染,3例死于顽固性心力衰竭。所有患者侧支血管直径最小2.5 mm,最粗9.4 mm,平均(5.3±2.1)mm。每例患者最少放置弹簧圈2枚,最多21枚,平均10.2枚;其中一支血管最多置入弹簧圈9枚。封堵血管最少1支,最多11支,平均3.7支。1例患者术后出现侧支血管再通(或出现新的侧支血管),再入导管室行侧支封堵术。术后14例患者并发肺部感染,3例出现肺水肿。75例患者随访12~75个月,均存活。4例TOF行心内修复术后NYHA心功能分级Ⅲ~Ⅳ级,其余患者心功能分级好于Ⅱ级。结论合并有体肺侧支的TOF患者在围术期采取内外科镶嵌治疗技术处理体肺侧支,可提高手术成功率,改善预后,减少术后并发症。

关键词(KeyWords)： 法洛四联症;体肺侧支;镶嵌治疗

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 卢蓉,尚小珂,沈群山,张刚成

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