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目的总结先天性主-肺动脉间隔缺损(APSD)的外科治疗经验。方法2000年10月到2009年3月共收治的主-肺动脉间隔缺损患者15例,年龄为2个月～5岁,平均1.8岁。按Richardson分形,Ⅰ型8例,Ⅱ型5例,Ⅲ型2例。其中Ⅰ型中2例经间隔缺损前壁径路涤纶补片修补,Ⅲ型中1例行人工血管右肺动脉-肺动脉干连接术,1例行直接切断右肺动脉与主肺动脉行端侧吻合。其余行经主动脉切口涤纶补片修补术,合并心脏畸形同期予以纠正。结果全组病例无死亡,8例随访5个月～3年,效果满意,复查超声心动图均无主-肺动脉残余分流,主动脉及肺动脉无狭窄,肺动脉压力较前明显下降。结论主-肺动脉间隔缺损(APSD)一经确诊应及早手术,手术年龄以婴儿早期为佳;术前诊断明确,充分认识病理生理及解剖类型,选择合适的手术方法是手术成功的关键。
Objective To summarize the experience of surgical treatment of congenital aortic-pulmonary septal defect (APSD). Methods Fifteen patients with aortocoronary pulmonary septal defect were treated from October 2000 to March 2009, ranging in age from 2 months to 5 years with an average of 1.8 years. According to Richardson fractal, 8 cases of type Ⅰ, 5 cases of type Ⅱ, 2 cases of type Ⅲ. Among them, 2 cases were repaired by Dacron patch in anterior wall of type Ⅰ and 1 case of artificial pulmonary artery-pulmonary artery in type Ⅲ, and 1 case was directly anastomosed to the right pulmonary artery and the main pulmonary artery. The rest through aortic incision polyester patch repair, combined with cardiac malformations to be corrected over the same period. Results There was no death in all the cases and 8 cases were followed up for 5 months to 3 years. The results were satisfactory. There was no residual shunt of the main pulmonary artery in the echocardiography. There was no stenosis in the aorta and pulmonary artery and the pulmonary artery pressure was significantly decreased. Conclusions The diagnosis of APSD should be performed as early as possible once the operation is diagnosed. The preoperative diagnosis is clear and the pathophysiology and anatomy are well understood. Choosing the appropriate surgical method is the key to successful operation.