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目的 探讨完全旷置右心手术对肺血分布的影响。方法 应用99Tcm 大颗粒聚合白蛋白肺灌注显像对 14例改良心外管道全腔静脉肺动脉连接术 (ETCPC)患者手术前后的肺血分布情况进行定量研究。结果 术后右肺与左肺血流灌注量比值为 1 16± 0 16 ,高于术前的 0 96± 0 11(P <0 0 5 )。术后肺野上段血流灌注量明显降低 ,与术前相比 ,差异有显著性 (P <0 0 5 ) ,下段血流灌注量增加 (P <0 0 1) ,其上 /下段比值为 0 2 2± 0 0 8,低于术前的 0 44± 0 0 9(P <0 0 1)。结论 改进的手术方法仍可保持右肺的相对优势灌注血流。其术后明显的坠积性肺淤血状态可能与远期肺动静脉瘘并发症发生率增加以及活动耐力受限有关
Objective To investigate the effect of complete excision of right heart on pulmonary blood distribution. Methods The distribution of pulmonary blood before and after operation in 14 patients with modified extracardiac total-vena cava pulmonary artery connection (ETCPC) was quantitatively studied with 99Tcm large-particle polymerized albumin lung perfusion imaging. Results The ratio of perfusion of right lung to left lung was 1 16 ± 0 16 postoperatively, which was higher than 0 96 ± 0 11 preoperatively (P 0 05). The amount of blood perfusion in the upper lung was significantly lower than that in the preoperative, with significant difference (P <0 05) and increased perfusion in the inferior segment (P 0 01) 0 2 2 ± 0 0 8, which was lower than preoperative 0 44 ± 0 0 9 (P 0 01). Conclusion The improved surgical method can still maintain the relative advantage of right lung perfusion. The postoperative significant hypostatic pulmonary congestion may be associated with increased incidence of pulmonary arteriovenous fistula complications and limited activity endurance