摘要
目的 评价不同方式的全腔静脉 -肺动脉连接术 (TCPC)术后的肺血分布特征 ,为选择最佳手术方式提供依据。方法 将 2 3例 TCPC术后的患者根据下腔静脉与肺动脉吻合方式的不同和有无左上腔静脉分为 4组。所有患者均在术后 30天内接受核素肺灌注显像检查 ,根据核素放射性计数在双侧肺内的分布 ,定性和定量分析上腔静脉、下腔静脉血液和全部肺血在左右肺内的分布特征。 结果 组 :下腔静脉血液全部或绝大多数回流到左肺 ;上腔静脉血液全部或绝大多数回流到右肺 ;全部静脉血液主要分布于左肺 ,左右肺血流量相比差别较大 (P≤ 0 .0 1) ,与生理性肺血分布不符。组 :上、下腔静脉血液及全部静脉血液比较均匀地分布于左右肺 ,左右肺血流量相比差别较小 (P≥0 .0 5 )。组 :下腔静脉血液大多数回流到右肺 ,左右肺血流量相比差别较大 (P≤ 0 .0 5 ) ;上腔静脉血液比较均匀地回流至左右肺 ,左右肺血流量相比差别较小 (P≥ 0 .0 5 ) ;全部肺血主要回流至右肺 ,左右肺血流量相比差别较大 (P≤0 .0 5 ) ,比较符合生理性肺血分布。组 :右上腔静脉血液全部回流至右肺 ,左上腔静脉血液全部回流至左肺 ,左右肺血流量相比差别较大 (P≤ 0 .0 1) ;下腔静脉血液多数分布至左肺 ,少数分布至右肺 。
Objective To assess the feature of pulmonary blood flow distribution after total cavopulmonary connection(TCPC) of different types, and provide basis for choosing the best type of it. Methods Between 1998.7 and 1999.12, 23 consecutive survival patients after TCPC underwent radionuclide lung perfusion imaging. According to the radionuclide counts in left and right lungs, the distribution of blood flow from superior vena cava (SVC), inferior vena cava (IVC) and the whole pulmonary blood flow in both lungs were quantitatively and qualitalively analysed. Results GroupⅠ: The flow ratios of the IVC to left lung was greater than that to the right lung; the flow ratios of the SVC to right lung was greater than that to the left lung and the whole pulmonary blood flowing dominantly to left lung (right lung vs. left lung, P ≤0.01), which is not identical with the physiological distribution. GroupⅡ: the flows from the SVC and IVC were mixed in the middle of the junction evenly distributed to the right and left lungs (right lung vs. left lung, P ≥0.05). GroupⅢ:most of IVC flow went to right lungs, and the flow of SVC major part evenly distributed to right and left lungs ( P ≥0 05), the whole pulmonary blood flow went dominantly to right lung (right lung vs. left lung, P ≤0.05), which accords with the physiological distribution. GroupⅣ: the flows from right SVC went totally to right lung ( P ≤0.01), and that from left SVC went to left lung completely( P ≤0.01); the flows from IVC went dominantly to left lung and a little to right lung ( P ≤0.05). Conclusion Different designs of TCPC can result in different pulmonary blood distribution, the best flow distribution between the left and right lungs can be obtained for an offset of the IVC anastomosis toward the right pulmonary artery with widening anastomosis for the patients without persistent left superior vena cava.
出处
《中国胸心血管外科临床杂志》
CAS
2001年第3期176-179,共4页
Chinese Journal of Clinical Thoracic and Cardiovascular Surgery
关键词
全腔静脉-肺动脉连接术
肺血分布
核素肺灌注显像
Total cavopulmonary connection
Pulmonary blood flow distribution
Radionuclide lung perfusion imaging
