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目的：评价采用同种带瓣管道行右室流出道重建术的临床效果，探讨影响手术效果及临床预后的因素。方法：回顾2002 年 11 月至2010 年11 月期间应用同种带瓣管道行右室流出道重建患者的临床资料，分析患者手术前后的一般信息、血流动力学表现与临床预后的关系。结果：行右室流出道重建术后49 例痊愈出院，5 例死亡，存活率90.7 %，死亡率9.3 %。手术前后比较右室流出道内径较术前明显增加，右室- 左室收缩压比值、右室- 肺动脉压差较术前明显降低，三尖瓣反流、肺动脉瓣反流较术前加重，肺动脉瓣狭窄较术前减轻。统计分析表明患者死亡的危险因素有术后右室平均压、术后肺动脉- 主动脉收缩压比值、术后二尖瓣反流。术后心胸比、术后肺动脉收缩压、术后肺动脉- 主动脉收缩压比值、术后三尖瓣反流可能和术后患者ICU 时间延长有关。 McGoon 指数、术后心胸比、术后肺动脉收缩压、术后右室平均压、术后肺动脉- 主动脉收缩压比值、合并动脉导管未闭、术后三尖瓣反流可能和术后患者呼吸机时间延长有关。结论：复杂先天性心脏病患者采用同种带瓣管道重建右室流出道可以取得较满意的临床效果，术后流出道梗阻矫正满意，可以防止肺动脉返流导致的心脏损害。

英文摘要:

Objective: To investigate the effect of right ventricular outflow tract reconstruction by homografts. Methods: Patients who underwent valved homograft conduit reconstruction of the right ventricular outflow tract in our institution, between November 2002 and November 2010, were retrospectively reviewed. Results: Total hospital mortality was 9.3 % (5 of 54). The diameter of right ventricular outflow tract, tricuspid regurgitation and pulmonary regurgitation increased after operation. The ratio of the systolic pressure between right and left ventricle, the pressure gradient between right ventricle and pulmonary and pulmonary stenosis decreased. Analysis show that the mean pressure of the right ventricle, ratio of systolic pressure between pulmonary and aorta after operation and mitral regurgitation may be risk factors for patient mortality. The cardiothoracic ratio, systolic pressure of pulmonary, ratio of systolic pressure between pulmonary and aorta and tricuspid regurgitation after operation maybe indicate longer ICU stays. The McGoon Index and exist of patent ductus arteriosus before operation and postoperative cardiothoracic ratio, systolic pressure of pulmonary, mean pressure of the right ventricle, ratio of systolic pressure between pulmonary and aorta and tricuspid regurgitation may predict longer mechanica1 ventilation. Conclusion: These results indicate that homografts show excellent outcomes in right ventricular outflow tract reconstruction.

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