张小飞,魏国荣,李保军,肖亦敏,肖明第

• 1:上海远大心胸医院心脏外科上海医大医院心脏大血管外科
• 2:上海东方医院心脏外科

摘要(Abstract)：

目的 评价介入封堵与外科结扎治疗伴有体肺侧支的法洛四联症（TOF）患者的临床疗效。方法 2009年4月至2019年6月，上海远大心胸医院应用介入封堵与外科结扎治疗伴有体肺侧支的TOF共185例。其中144例患者行体肺侧支介入封堵术联合外科手术（介入封堵组），41例术中外科结扎体肺侧支血管后行外科矫治术（外科结扎组）。结果 外科结扎组总的重症监护病房（ICU）滞留时间[7.3(0.6,126.0)d比4.7(0.5,8.8)d,P=0.027]、总的气管内插管时间[129(10,2 398)h比19(5,113)h,P=0.009]以及总的住院时间[38(17,140)d比23(7,54)d,P=0.012]，并发症发生率（9.8%比5.6%,P<0.001）和死亡率（9.8%比0,P<0.001）明显高于介入封堵组，差异均有统计学意义。介入封堵组144例患者主动脉造影发现425支广泛的体肺侧支血管，对其中的390支进行封堵治疗，封堵成功率为91.7%，无手术死亡病例，其中重大并发症包括3例术后咯血，5例二次开胸止血，2例二次体肺侧支封堵术。外科结扎组41例患者共结扎体肺侧支74支；其中重大并发症包括2例延迟关胸，2例二次开胸止血，4例死亡（死因分别是左下肺实变、呼吸功能衰竭、低心排综合征、心功能衰竭）。结论 相对于外科手术结扎处理体肺侧支血管，介入封堵手术可简化广泛的体肺侧支血管患者的手术过程，提高手术成功率。

关键词(KeyWords)： 法洛四联症;介入封堵;外科结扎;体肺侧支

Abstract:

Keywords:

基金项目(Foundation):

作者(Author): 张小飞,魏国荣,李保军,肖亦敏,肖明第

参考文献(References)：

• [1]汪曾炜，刘维永，张宝仁．心脏外科学[M]．北京：人民军医出版社，2003:878.
• [2] Zuberbuhler JR,Dankner E,Zoltun R,et a1.Tissue adhesive closure of aortic-pulmonary communications[J].Am Heart J,1974, 88(1):41-46.
• [3] Fuhrman BP,Bass JL,Castaneda-Zuniga W,et a1.Coil embolization of congenital thoracic vascular anomalies in infants and children[J].Circulation,1984,70(2):285-289.
• [4] Yamamoto S, Nozawa T, Aizawa T, et al. Transcatheter embolization of bronchial collateral arteries prior to intracardiac operation for tetralogy of Fallot[J]. J Thorac Cardiovasc Surg, 1979, 78(5):739-743.
• [5] Rome JJ, Mayer JE, Castaneda AR, et al. Tetralogy of Fallot with pulmonary atresia. Rehabilitation of diminutive pulmonary arteries[J]. Circulation,1993, 88(4 Pt 1):1691-1698.
• [6] Kreutzer J, Perry SB, Jonas RA, et al. Tetralogy of Fallot with diminutive pulmonary arteries:preoperative pulmonary valve dilation and transcatheter rehabilitation of pulmonary arteries[J]. J Am Coll Cardiol,1996,27(7):1741-1747.
• [7] Sharma S, Kothari SS, Krishnakumar R, et al. Systemic-topulmonary artery collateral vessels and surgical shunts in patients with cyanotic congenital heart disease:perioperative treatment by transcatheter embolization[J]. Am J Roentgenol, 1995, 164(4):1505-1510.
• [8]郭保静，戴辰程，李强强，等．法洛四联症外科矫治手术前后的介入干预治疗[J]．心肺血管病杂志，2014,33(4):493-502.
• [9] Perry SB, Radtke W, Fellows KE, et al. Coil embolization to occlude aortopulmonary collateral vessels and shunts in patients with congenital heart disease[J]. J Am Coll Cardiol, 1989,13(1):100-108.
• [10] Sato Y, Ogino H, Hara M, et al. Embolization of collateral vessels using mechanically detachable coils in young children with congenital heart disease[J]. Cardiovasc Intervent Radiol,2003, 26(6):528-533.
• [11] Guevara JH,Zorrilla-Vaca A,Silva-Gordillo GC.The utility of preoperative level of erythrocytosis in the prediction of postoperative blood loss and 30-day mortality in patients with tetralogy of fallot[J]. Ann Card Anaesth,2017,20(2):188-192.