室间隔完整的超龄大动脉转位病儿最佳手术方式的选择  

Optimal surgical managemeat for transposition of great arteries with intact ventricular septum in infant older than 21 days

作　　者：吴洪斌[1] 李守军[1] 胡盛寿[1] 刘迎龙[1] 沈向东[1] 王旭[1] 李永青[1] 

机构地区：[1]中国医学科学院心血管病研究所阜外心血管病医院心外科,北京100037

出　　处：《中华胸心血管外科杂志》2008年第4期236-238,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的探讨超龄室间隔完整的大动脉转位（TGA-IVS）病儿手术方式的选择和治疗的早、中期结果。方法2000年3月至2007年6月，收治年龄超过3周的TGA．IVS病儿36例，占同期TGA行动脉调转术（AS0）病儿的23．9％。男26例，女10例；年龄22—2190d，其中小于3个月20例，大于1岁3例；体重3．5—19．0kg，平均（5．4±2．9）kg。依据手术方式分为一期手术组（A组）21例和分期手术组（B组）15例。B组先进行左心室功能锻炼，二期再进行ASO，其中快速二期手术14例，长期二期手术1例。两组的平均年龄和术前左、右心室压力比值（LVP／RVP）差异有统计学意义。32例随访2—74个月，平均（20．3±19．1）个月。结果围术期死亡2例，分别死于肺部感染和肾功能衰竭，巨细胞病毒感染引起的肝肾功能衰竭。术后3。6个月死亡3例，3年生存率为88．8％。生存病儿生活质量和生长发育良好，左心室收缩功能正常。结论错过手术最佳时机的TGA-IVS病儿，参考术前超声和术中测压情况合理选择一期或分期ASO，并加强术后管理，治疗效果满意。Objective To discuss the optimal surgical management for transposition of great arteries with intact ventricular septurn （TGA-IVS） in infants older than21 days,Methods Between March2000 to June2007, 36TGA-IVS infants older than3 weeks including 20 cases younger than 3 month and 3 older than 1 year, were admitted, There were The mean body weight was （5.4±2.9） kg. All patients underwent artery swith operation （ASO）, 21 patients in one-stage ASO （group A） and 15 in two-stage ASO （group B）. There was significant different in mean age, body weight and LVP/RVP between two groups, Rapid two-stage ASO in 14 eases with banding of pulmonary artery and/no Blalock-Taussig shunts first and underdone ASO after （ 12.8 ± 8.1） days, Long interval two-stage ASO in 1 ease who underdone ASO 6 months later because of LVEF less than 40%, Median follow-up time was 20.3 （2- 74） months. Results There were 2 early deaths （1 from group A and 1 from group B） and 3 late deaths （all from group A）. Theaetuarial survival rate was 88.8% at 3years.Conclusion Decided on the basis of preoperative ultrasound and intraoperative presaure measurement, one or two-stage ASO may provide satisfactory effect on transposition of great arteries with intact ventricular septum in infants eider than 21 days.

关 键 词：心脏缺损  先天性 大血管错位 心脏外科手术 

分 类 号：R686[医药卫生—骨科学]