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目的评价体-肺侧支栓塞术在重症法洛四联症(F4)患者“一站式”杂交治疗(介入治疗+外科根治术)中的临床价值。方法2007年5月至12月,共26例重症F4患者(男12例,女14例),平均年龄5.2岁(5个月~29岁),在我院Siemens杂交手术室系统内完成了“一站式”治疗:全麻插管下先完成主动脉及心室造影,若发现有明确的体-肺侧支血管即予以经导管栓塞,随后立即完成外科根治术(杂交组)。选择同期住院仅接受单纯外科根治术的26例重症F4患者作为对照组(单纯外科组)。两组患者在性别、年龄、体重组成方面差异无统计学意义。对两组患者的住院时间、术后ICU监护时间、呼吸机辅助时间、体外循环时间等指标进行对比研究。结果杂交组中有20例患者接受了体-肺侧支栓塞术,其中2例因侧支血管太细放弃栓塞、4例未发现明确体-肺侧支血管。共采用Cook不可控弹簧圈50枚栓塞了38支侧支血管,另有两例采用明胶海绵团块栓塞侧支血管,所有患者均获栓塞成功,无异位栓塞发生。杂交组术后恢复良好,无死亡病例。单纯外科组有两例患者外科术后发生“灌注肺”现象,术后2~5d内接受了补救性体-肺侧支栓塞术,1例死于术后心功能不全。杂交组较对照组总住院时间(19.5d比25.6d)、术后ICU监护时间(50.3h比82.6h)、术后呼吸机辅助时间(18.5h比38.6h)和术中体外循环时间(105.1min比131.3min)均要明显缩短(均为P<0.05)。结论外科术前体-肺侧支栓塞术能缩短手术时间、提供良好手术野、减少术后灌注肺的发生,在F4患者“一站式”杂交治疗能提高外科根治术的疗效及预后。
Objective To evaluate the clinical value of body-pulmonary artery occlusion in the treatment of severe tetralogy of Fallot (F4) patients with “one-stop” hybridization (interventional therapy + radical surgery). Methods From May 2007 to December 2007, a total of 26 severe F4 patients (12 males and 14 females) with a mean age of 5.2 years (ranged from 5 months to 29 years) were enrolled in the Siemens operating room system. “One-stop” treatment: Anesthesia and ventriculography are performed under general intubation. If there is a definite body-lung collateral vessel, catheter embolization is performed, and surgical radical surgery (hybridization group) is completed immediately. Twenty-six patients with severe F4 who underwent radical surgery alone during the same period of hospitalization were selected as the control group (simple surgery group). There was no significant difference in gender, age and weight between the two groups. The two groups of patients in hospital time, ICU monitoring time after surgery, ventilator support time, cardiopulmonary bypass time and other indicators were compared. Results Twenty patients in the hybrid group received body-pulmonary artery occlusion, of which 2 patients were too small to give up embolism because of collateral vessels and 4 had no definite body-lung collateral vessels. A total of 38 cannulated lateral branch vessels were enrolled by Cook uncontrollable coil, and two cases were embolized with gelatin sponge block. All patients received successful embolization without ectopic embolization. The hybrid group recovered well without any deaths. In the simple surgical group, two patients underwent surgical resection of “lung perfusion” after surgery, and received a remedy for pulmonary embolism within 2 to 5 days after operation. One patient died of postoperative cardiac insufficiency. Compared with the control group, the total hospitalization time (19.5d vs. 25.6d), ICU monitoring time (50.3h vs 82.6h), postoperative ventilator support time (18.5h vs 38.6h) and intraoperative cardiopulmonary bypass time (105.1 min than 131.3 min) were significantly shorter (both P <0.05). Conclusion Preoperative surgical pulmonary embolism can shorten the operation time, provide a good surgical field, and reduce the incidence of postoperative perfusion of lung. The treatment of FK with “one-stop” hybrid therapy can improve the curative effect and prognosis of surgical radical surgery .