Salminen Jukka T, Mattila Ilkka P, Puntila Juha T, Sairanen Heikki I
Department of Paediatric Cardiac Surgery, Hospital for Children and Adolescents, University of Helsinki, P.O.B. 281, 00029 Helsinki, Finland.
Interact Cardiovasc Thorac Surg. 2011 Feb;12(2):270-2. doi: 10.1510/icvts.2010.241448. Epub 2010 Nov 16.
Reoperations for congenital cardiac defects are associated with an increased surgical risk due to adhesions. We compared the capability of a polytetrafluoroethylene (PTFE) membrane, synthetic polyethyleneglycol hydrogel (PEG), and a combination of them to prevent postoperative pericardial adhesions in patients with hypoplastic left heart syndrome (HLHS). Eighteen consecutive patients with HLHS were included. At the end of the Norwood I operation the cranial and the caudal half of the heart of each patient was randomized to receive a PTFE membrane, a synthetic PEG, a combination of them, or no treatment (control). Tenacity and density of adhesions, epicardial visibility, and adhesions between the heart and the sternum were analyzed semiquantitatively at a subsequent bidirectional Glenn operation. The PTFE membrane significantly decreased adhesion formation between the heart and the sternum (P<0.001). However, the PTFE membrane, with or without synthetic PEG, impaired epicardial visibility (P<0.05) when compared to synthetic PEG or controls. Synthetic PEG alone did not significantly reduce the formation of pericardial adhesions. Tenacity and density of adhesions were not affected by any of the treatment modalities. The PTFE membrane significantly decreases postoperative adhesions between the heart and the sternum, but impairs epicardial visibility. Synthetic PEG does not prevent formation of pericardial adhesions.
由于粘连，先天性心脏缺陷的再次手术与手术风险增加相关。我们比较了聚四氟乙烯（PTFE）膜、合成聚乙二醇水凝胶（PEG）及其组合预防左心发育不全综合征（HLHS）患者术后心包粘连的能力。纳入了连续18例HLHS患者。在诺伍德I期手术结束时，将每位患者心脏的头侧和尾侧随机分为接受PTFE膜、合成PEG、它们的组合或不治疗（对照）。在随后的双向格林手术中，对粘连的韧性和密度、心外膜可见度以及心脏与胸骨之间的粘连进行半定量分析。PTFE膜显著减少了心脏与胸骨之间粘连的形成（P<0.001）。然而，与合成PEG或对照相比，PTFE膜无论有无合成PEG，均损害了心外膜可见度（P<0.05）。单独使用合成PEG并没有显著减少心包粘连的形成。粘连的韧性和密度不受任何一种治疗方式的影响。PTFE膜显著减少了术后心脏与胸骨之间的粘连，但损害了心外膜可见度。合成PEG不能预防心包粘连的形成。
