对全腔-肺吻合手术开窗技术的计算流体力学研究

Total cavo-pulmonary connections were widely used in the treatment of functional single ventricle. By anastomosing the superior and inferior venae cavae to the pulmonary arteries, it directed the venous blood to the lungs directly without passing through the heart. Fenestration on the tunnel or conduit is one important strategy in this type of procedures, which shunts part of the venous blood to the common atrium directly instead of passing through the lungs. Appropriate fenestration will help the patients which have high lung resistance or heart dysfunction preoperatively to survive through the perioperative period. However inappropriate fenestration will lead to insufficient or excessive right to left shunt which causes iatrogenic damage to the patients. Unfortunately, till now, hemodynamic study focusing on the fenestration is still rare and the fenestration made during the procedures is far from individual design. We plan to investigate fenestrated total cavo-pulmonary connections in this study utilizing computational fluid dynamics and virtual operation technology to analyze the influence of different fenestration on the hemodynamic features of the whole circulation, which aims to provide solution to the surgeons when making fenestration design for an individual patient before the operations. Additionally, new types of fenestration will be designed and investigated by this method to explore the possibility of a more reasonable type of fenestration.

功能性单心室患儿的手术治疗需要将上、下腔静脉分别与肺动脉进行吻合，从而使体循环静脉血不经过心脏而直接回流到肺循环进行氧合，这种手术方式被称为全腔-肺吻合术。此类手术中一项重要的手术策略是板障或管道的开窗，通过开窗可以构建体静脉端与体循环心房之间的分流通路。合理的开窗方案对帮助术前肺阻力高或者心功能不全的高危患儿度过围手术期起到了非常重要的作用，但不当的开窗导致的分流过小或过度右向左分流却会造成医源性伤害。遗憾的是目前针对开窗的血流生理研究尚十分有限，术中开窗方案也不能做到精准的个体化设计。我们拟利用计算流体力学方法并结合虚拟手术技术对包含开窗的全腔-肺吻合结构进行数值模拟研究，明确不同开窗特征对循环血流动力学的影响，探索术前为患者选择和制定最优化的个体化开窗方案的方法，并积极探索更加合理的新型开窗方式。

全腔-肺吻合术是广泛用于治疗功能性单心室患儿的手术，术中将上、下腔静脉分别与肺动脉吻合，使体循环静脉血不经过心脏而直接回流到肺循环进行氧合。此类手术中一项重要的手术策略是板障或管道的开窗，通过开窗可以构建体静脉端与体循环心房之间的分流通路。合理的开窗方案对帮助术前肺阻力高或者心功能不全的高危患儿度过围手术期至关重要，但不当的开窗导致的分流过小或过度右向左分流却会造成医源性伤害。针对目前有限的开窗血流生理研究、以及缺乏精准的个体化设计开窗方案问题，我们利用计算流体力学、计算机辅助设计、与体外流体实验，对包含开窗的全腔-肺吻合结构进行虚拟手术设计与数值模拟研究，确定了患者个体化TCPC开窗模型的最佳CFD建模方法，明确不同开窗方式及数量、大小、位置等因素对TCPC循环血流动力学的影响，术前为患者选择和制定最优化的个体化开窗方案，并积极探索更加合理的新型开窗方式，为优化TCPC开窗个体化手术治疗提供有益的参考。