动脉导管支架在动脉导管依赖性右心发育不良综合征中的应用

目的总结动脉导管支架置入术在动脉导管依赖性右心发育不良综合征(HRHS)患儿中的应用经验。方法回顾性研究2012年1月至2019年1月在青岛市妇女儿童医院行动脉导管支架置入术的7例患儿的临床资料,其中4例为室间隔完整的肺动脉闭锁(PA-IVS)伴HRHS,3例为室间隔完整的危重肺动脉瓣狭窄伴HRHS。以同医院同期行外科Blalock-Taussig(B-T)分流术的9例PA-IVS伴HRHS患儿作为对照,比较两组患儿手术时间、住院时间、重症监护时间、病死率等临床资料。组间比较采用t检验及Mann-WhitneyU检验。结果动脉导管支架置入术患儿年龄和体重与B-T分流组相比差异无统计学意义18(7~100)]比17(1~142)日龄,U=31.000,P>0.05;(3.8±1.1)比(3.7±1.3)kg,t=0.272,P>0.05]。动脉导管支架组手术时间(108±7)比(160±49)min]、重症监护时间(3.4±1.0)比(6.3±4.5)d]、总住院时间(10.3±1.0)比(26.3±1.0)d]均明显低于B-T分流组,差异有统计学意义(t=-4.304、-8.692、-7.822,P均<0.05)。动脉导管支架置入后经皮血氧饱和度较术前明显改善(0.723±0.125比0.926±0.005,t=-6.044,P<0.05)。动脉导管支架直径为3.5~4.0 mm,支架长度为16~21 mm。动脉导管支架组患儿无血管损伤、急性血栓、导管痉挛及死亡,随访期间无支架移位、狭窄发生。9例B-T分流组患儿围术期死亡3例。动脉导管支架组3例肺动脉闭锁患儿分别在术后6、9、9个月时行肺动脉瓣切开术及双向Glenn手术。结论对于动脉导管依赖性HRHS患儿,动脉导管支架置入术是一种可行、有效、安全、微创的手术方法,可作为早期外科B-T分流术的替代方法。

Application of arterial duct stent in ductus-dependent hypoplastic right heart syndrome

Objective To summarize the experience of arterial duct(AD)stenting in children with ductus-dependent hypoplastic right heart syndrome(HRHS).Methods Seven children including 4 cases of pulmonary atresia with intact ventricular septum(PA-IVS)with HRHS and 3 cases of critical pulmonary stenosis(CPS)-IVS with HRHS underwent AD stenting in Qingdao Women and Children′s Hospital between January 2012 and January 2019.During the same period,9 patients of PA-IVS with HRHS received Blalock Taussig(B-T)shunt.Two groups of children on the operation time,hospital stay time,intensive care time and mortality were compared.T test or Mann-Whitney U test was used for comparison between the two groups.Results There was no significant difference in the age(18(7-100)vs.17(1-142)d,U=31.000,P>0.05)and weight((3.8±1.1)vs.(3.7±1.3)kg,t=0.272,P>0.05)between the AD stenting group and the B-T group.The operation time((108±7)vs.(160±49)min,t=-4.304),intensive care time((3.4±1.0)vs.(6.3±4.5)d,t=-8.692)and total hospitalization time((10.3±1.0)vs.(26.3±1.0)d,t=-7.822)in the AD stenting group were differed significantly compared with the B-T group(all P<0.05).The transcutaneous oxygen saturation improved significantly(0.723±0.125 vs.0.926±0.005,t=-6.044,P<0.05)after AD stenting.The diameter of AD stent ranged from 3.5 to 4.0 mm,and the length of AD stent was 16-21 mm.There were no complications such as vascular injury,acute thrombus,catheter spasm and death in the AD stenting group.The mortality of children in the B-T group was 3 in 9 cases.Three cases in the AD stenting group received pulmonary valvulotomy and bilateral Glenn operation at 6,9 and 9 months after AD stenting,respectively.Conclusions AD stenting is a feasible,effective,safe and minimally invasive procedure for children with ductus-dependent HRHS.It can even be used as an alternative to B-T shunt.