78例动脉调转手术在复杂先天性心脏病治疗中的临床应用  

Clinical Application of Arterial Switch Operation for the Complex Congenital Heart Defects:A Review of 78 Cases

作　　者：刘迎龙[1] 胡盛寿[1] 沈向东[1] 李守军[1] 王旭[1] 闫军[1] 崔彬[1] 

机构地区：[1]中国医学科学院中国协和医科大学心血管病研究所阜外心血管病医院心外科,北京市100037

出　　处：《中国循环杂志》2005年第6期418-421,共4页Chinese Circulation Journal

摘　　要：目的:回顾总结近年来动脉调转术(ASO)治疗心室大动脉连接异常复杂先天性心脏病(先心病)的手术疗效,探讨手术适应证。方法:2000年1月至2004年12月,对78例患儿行动脉调转术,其中室间隔完整型[或含小的室间隔缺损(VSD)]大动脉转位(TGA),为室间隔完整型组30例;<6个月的VSD型TGA和右心室双出口合并肺动脉瓣下VSD(简称TaussigBing畸形),为<6个月VSD型组20例;>6个月合并中～重度肺动脉高压的VSD型TGA和TaussigBing畸形,为>6个月VSD型组24例;矫正型TGA为矫正型TGA组4例。平均年龄(8.55±14.84)个月(2天～11岁)。合并主要畸形:左心室流出道狭窄7例,肺动脉瓣轻～中度狭窄7例,肺动脉瓣重度狭窄1例,主动脉弓中断1例,肺动脉瓣下隔膜1例,主动脉瓣下隔膜1例,镜面右位心1例。在全麻、低温(18～22℃)、低流量[50ml/(kg·min)]体外循环下完成动脉调转术,合并畸形者同期矫治。结果:全组病死率为14.1%(11/78)。其中室间隔完整型组、<6个月VSD型组、>6个月VSD型组和矫正型TGA组病死率分别是13.3%(4/30)、15.0%(3/20)、12.5%(3/24)、25.0%(1/4)。67例患者痊愈出院。平均随诊13.5±7.9(0.5～56)个月,心功能明显改善,紫绀消失,活动量增加,发育正常,无死亡和远期并发症发生。结论:动脉调转术是解剖矫治TGA、TaussigBing畸形及矫正型TGA的首选术式。对年龄较大(>6个月)、合并中～重度肺动脉高压、合并复杂畸形同期矫治以及一期姑息术后的二期动脉调转术患儿,手术疗效及中期随访结果满意。Objective： To summarize the clinical experience of the arterial switch operation （ASO） for the complex congenital heart defects and discuss the indication of such operation. Methods ： Between January 2000 and December 2004,of 78 consecutive neonatal and infants, aged from 2 days to l l years （8. 55 ± 14. 84 months）with the mean body weight was 5.94 ±3.23 kg（2. 6-22.0 kg）, underwent the arterial switch operation. Thirty infants suffered from the transposition of the great arteries and intact ventricular septal（TGA-IVS） ,20 infants（ 〈 6 month） with transposition of the great arteries and ventricular septal defect （TGA-VSD） or Taussig-Bing anomal （TBA）, 24 infants （ 〉 6 month） suffered from the TGA and VSD or Taussig-Bing anomal with the middle-severe pulmonary hypertension（PH） and 4 infants suffered from the congenital corrected transposition of the great arteries（ccTGA）. The operation was performed under general anesthesia and extracorporeal circulation with the low temperature and low volume blood flow. Results： The overall operative mortality rate was 14. 1% （11/78 ）. The operative mortality rate was 13.3% （4/30）, 15.0% （3/20）, 12. 5 % （ 3/24 ） and 25.0% （ 1/4 ） for each group. 67 patients discharged from hospital. Follows-up （ 0. 5 to 56 months, 13.5 ± 7.9 months）showed survivals have no complications and death, cyanosis was significantly reduced, physical activities increased obviously. Conclusions ： ASO remains the procedure of choice for the treatment of various forms of TGA ,TBA or ccTGA with acceptableearly and late outcome in terms of overall survival and free reoperation. For patients with older year and the pulmonary hypertension, with the left ventricular ouflow tract（LVOT） obstruction, the interrupted aortic arch and other complications, the operation also has satisfactory results.

关 键 词：心脏缺损 先天性 心脏外科手术 大动脉转位 右心室双出口 手术适应证 

分 类 号：R541[医药卫生—心血管疾病]