Murthy K S, Rao S G, Naik S K, Coelho R, Krishnan U S, Cherian K M
Institute of Cardiovascular Diseases, Madras Medical Mission, Mogappair, Chennai, India.
Ann Thorac Surg. 1999 Mar;67(3):760-4. doi: 10.1016/s0003-4975(99)00077-6.
The purpose of this study was to evaluate the results of various surgical modalities that have been evolving for the treatment of ventricular septal defect, pulmonary atresia, and major aortopulmonary collateral arteries.
From 1993 to May 1997, 14 patients (group 1) were treated with staged unifocalization through thoracotomies and final repair by midsternotomy. From June 1997 to February 1998, 10 patients (group 2) were treated with midsternotomy, single-stage complete unifocalization, and repair.
In group 1, 14 patients had 21 procedures (1.5 procedures per patient), of which 3 patients (21%) had final correction. There were two deaths (14%). One patient died of blocked shunt. Another patient who had aneurysmal dilation of homograft tubes that were used for unifocalization died after final repair because of low cardiac output. In group 2, 10 patients had ten surgical procedures for complete unifocalization and 9 of 10 (90%) of them achieved final correction. One patient with low cardiac output in whom we did not close the ventricular septal defect died (10%) of suprasystemic right ventricular pressure.
In single-stage complete unifocalization, more patients had final correction. It reduces the number of operations and hospitalization and hence is more cost effective than multistaged procedures.
本研究的目的是评估各种不断发展的用于治疗室间隔缺损、肺动脉闭锁和主要体肺侧支动脉的手术方式的效果。
1993年至1997年5月，14例患者（第1组）通过开胸分期进行单灶化治疗，最终通过胸骨正中切开术进行修复。1997年6月至1998年2月，10例患者（第2组）接受胸骨正中切开术、单阶段完全单灶化和修复治疗。
在第1组中，14例患者共进行了21次手术（每位患者1.5次手术），其中3例患者（21%）完成了最终矫正。有2例死亡（14%）。1例患者死于分流阻塞。另1例患者在单灶化过程中使用的同种异体移植血管出现动脉瘤样扩张，最终修复后因心输出量低死亡。在第2组中，10例患者进行了10次完全单灶化的外科手术，其中9例（90%）完成了最终矫正。1例心输出量低且未关闭室间隔缺损的患者死于（10%）体循环高压的右心室压力。
在单阶段完全单灶化治疗中，更多患者完成了最终矫正。它减少了手术次数和住院时间，因此比多阶段手术更具成本效益。
