二期Fontan术治疗小儿复杂先天性心脏病  

Two stage Fontan operation for complex congenital heart disease in children

作　　者：郑景浩[1] 徐志伟[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海交通大学医学院附属新华医院上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2007年第2期97-99,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

基　　金：本课题受上海市科学技术委员会基金项目（024119020）资助

摘　　要：目的总结二期Fontan术纠治小儿危重复杂先天性心脏病治疗经验。方法28例复杂心内畸形病儿进行二期Fontan术。年龄3．0～16．5岁,平均（7．3±3．8）岁;体重13．5～61．0 kg,平均（21．0±5．5）kg。主要为无脾综合征、多脾综合征、三尖瓣闭锁（TA）及房室连接不一致的右室双出口（DORV）等。一期分别行单侧Glenn、双侧Glenn、半Fontan术。两次手术间隔0．8～7．3年,平均（3．9±2．8）年,其中5例在Glenn术前行体肺动脉分流术。术前均行二维多普勒超声检查,23例行心导管和心血管造影检查。术中采用4种不同的连接方法将下腔静脉的血引流入右肺动脉,完成二期的全腔肺血管连接术（TCPC）。结果术后死亡4例（14．2％）。虽然采取综合措施降低肺血管阻力和增加回心血量,术后仍有12例发生低心输出量综合征,其中肾功能受损导致无尿而行腹膜透析术8例。2例右房和腔静脉内有血栓形成,再次进胸手术取栓后好转。吸入空气的动脉血氧饱和度在0．89～0．95。门诊随访3个月～2年,无死亡。无慢性渗出、蛋白丢失肠病等并发症。结论分期TCPC术可放宽对复杂先天性心脏病手术指征,并能增加手术成功率。分期TCPC术中心外管道的应用有许多优点。Objective To review the experiences of two stage Fontan operation for complex congenital heart disease in children. Methods There are 28 patients with cyanotic complex congenital heart disease. Aged from 3.0 to 16.5 years and weighted from 13.5 to 61.0 kg. The main diseases included polysplenia, asplenia syndrome, tricuspid atresia. The initial surgical procedures included Glenn, double-Glenn or hemi-Fontan. Pre-operative assessment was performed in 23 patients by ECHO and Cath. The time interval between two operations was 0.8 - 7.3 years. The two-stage Fontan operation was performed through fore： different methods of connecting blood flow IVC to right pulmonary artery. Results The mortality was 14.2% （4 cases）. Early postoperative complications were low cardiac output in 12 patients, renal dysfunction in. Re-operation was performed operation in two eases to get rid of the thrombus in the atrium. The 02 saturation ranged 0.89 - 0.95. The time of follow-up is from 3 months to 2 years and the results are satisfying. Conclusion two-stage Fontan operation （two stage TCPC） suited more for complex congenital heart disease such as polysplenia and asplenia syndrome extracardiac conduit is used in the two stage Font,an operation with much benefit.

关 键 词：心脏缺损 先天性 FONTAN手术 

分 类 号：R686[医药卫生—骨科学]