应用系列改良Fontan手术治疗复杂先天性心脏病  

Surgical Treatment of Complicated Congenital Heart Diseases with the Modified Fontan Operation

作　　者：孙国成[1] 郑奇军[1] 易定华[1] 朱海龙[1] 赵壁君[1] 刘维永[1] 

机构地区：[1]第四军医大学西京医院心脏外科,西安710032

出　　处：《中国胸心血管外科临床杂志》2008年第6期406-410,共5页Chinese Journal of Clinical Thoracic and Cardiovascular Surgery

基　　金：国家"十一五"科技支撑计划(2006BAI01A08)~~

摘　　要：目的探讨系列改良Fontan手术的特点和治疗复杂先天性心脏病的效果,进一步提高对其临床应用的认识。方法回顾性分析1992年9月～2006年6月期间77例复杂先天性心脏病患者行改良Fontan手术治疗的临床资料,其中行右心房-肺动脉吻合术21例,心房内板障或管道全腔静脉-肺动脉连接术28例,心外人工管道全腔静脉-肺动脉连接术24例,自体右房壁管道全腔静脉-肺动脉连接术2例,自体带蒂心包心外管道全腔静脉-肺动脉连接术1例,主肺动脉与下腔静脉吻合全腔静脉-肺动脉连接术1例。结果术后早期死亡5例,其中死于心力衰竭3例,突发心律失常1例,脑出血1例。再次手术1例,术后早期生存率93.5%(72/77),手术成功率92.0%。左心室舒张期末内径(LVEDD)较术前减小(52.5±7.8mmvs.62.5±11.0mm,P=0.013),左心室射血分数(LVEF)较术前增加(68.5%±4.0%vs.62.0%±4.5%,P=0.032)。随访63例,随访率87.5%(63/72),随访时间1～15年。随访期间死亡4例,远期再次手术1例,远期生存率88.3%,手术成功率86.0%。结论在复杂先天性心脏病的治疗中,改良Fontan手术有良好的疗效;同时根据具体解剖结构可选择不同的手术方式。Objective To investigate the operative characteristic and results of the modified Fontan procedure, and improve the application of Fontan procedure in the clinic. Methods From Sep. 1992 to June 2006, 77 cases （aged 2.5 years to 20.0 years） with a wide range of complicated congenital heart diseases underwent the modified Fontan procedure. Right atrium-pulmonary artery connection were performed in 21 cases, intra-atrium fenestrated baffle or conduit total cavopulmonary connection were performed in 28 cases, extracardiac conduit total eavopulmonary connection were performed in 24 cases, atrium wall lateral tunnel total cavopulmonary anastomosis were performed in 2 cases, extracardiac pericardial tube total cavopulmonary anastomosis was performed in 1 case, and extracardiac direct total cavopulmonary connection was performed in 1 case. Results In early postoperative period, there were 1 case of successful re-operation and 5 death, the cause of death were heart failure （3 cases）, arrhythmia （1 case） and cerebral hemorrhage （1 case）. The early survival rate was 93.5%（72/77）, with 92.0% free from failure. The eject fractions of left ventricle （LVEF） after operation were increased than those before operation （68.5%±4.0% vs. 62.0±4.5% ,P=0. 032） and left ventricular end-diastolic diameter （LVEDD） were decreased than those before operation （52. 5±7. 8mm vs. 62. 5±11. 0mm, P=0. 013）. A total of 63 cases （87. 5%） were followed up from 1 to 15 years after operation. In late postoperative period, there were 4 cases of death, and 1 of successful re-operation. Late survival rate was 88. 3%, with 86. 0% free from failure. Conclusion In the treatment for complicated congenital heart diseases, the modified Fontan procedure could result in good early and long-term outcome, and the choices for surgical procedure are various.

关 键 词：改良FONTAN手术 复杂先天性心脏病 并发症 

分 类 号：R654.2[医药卫生—外科学]