采用心上径路矫治心上型完全性肺静脉异位引流的体会  

Treatment of supracardiac total anomalous pulmonary venous return via superior approach

作　　者：陈元恒[1] 杨军民[1] 张红超[1] 于鲁峰[1] 李令珂[1] 徐金星[1] 

机构地区：[1]空军总医院心血管外科,北京100142

出　　处：《解放军医学杂志》2009年第7期881-882,共2页Medical Journal of Chinese People's Liberation Army

摘　　要：目的探讨心上径路矫治心上型完全性肺静脉异位引流的临床效果。方法2005年1月-2008年1月采用心上径路矫治心上型完全性肺静脉异位引流5例,女3例,男2例,年龄7.0±3.9(2～13)岁。术前5例患者均有不同程度的发绀,血氧饱和度为0.89～0.93。胸骨左缘2～3肋间可闻及2～3/6级收缩期杂音,肺动脉第二音亢进分裂。心电图示窦性心律,右心房肥大,右心室肥厚。胸片示肺血增多,肺动脉段突出,右心房室增大,心影呈"雪人征",心胸比率0.55～0.70。超声心动图检查示心上型完全性肺静脉异位引流,肺静脉总干入垂直静脉至无名静脉,房间隔缺损13～17mm,心房水平右向左分流,肺动脉高压[73.8±5.3(67～80)mmHg],其中2例合并三尖瓣关闭不全。在全麻体外循环下经左房顶部径路进行矫治,其中2例同期行三尖瓣成形。5例患者主动脉阻断时间55.6±8.7(43～65)min,体外循环时间86.8±12.9(72～106)min,呼吸机辅助时间17.8±3.5(8～22)h,4例重度肺动脉高压患者术后早期应用硝普钠、前列腺素E和多巴胺处理。结果5例患者均治愈出院,随访0.5～2.5年,生长发育良好,无心律失常和吻合口狭窄。结论采用心上径路矫治心上型完全性肺静脉异位引流,手术操作方便,显露好,可减少心律失常和吻合口狭窄的发生。Objective To review the surgical treatment of supracardiac total anomalous pulmonary venous return （TAPVR） via superior approach. Methods Five patients （2 males and 3 females, aged from 2 to13 with an average of 7. 0±3. 9 years） with supracardiac TAPVR underwent surgery from Jan. 2005 to Jan. 2008. All patients showed cyanosis at resting state with the SaO2 of femoral artery ranged from 0. 89 to 0. 93; cardiac auscultation revealed 2-3/6 degree of systolic murmur and split second heart sound; EEG showed sinus rhythm, right auricle enlargement, right ventricle hypertrophy; echocardiography revealed supracardiac total anomalous pulmonary venous return, atrial septal defect （13-17mm）, and 73. 8±5.3mmHg of pulmonary artery pressure. The direct anastomosis of the top of left atrium and common pulmonary venous trunk were performed under general anesthesia and extracorporeal circulation in the 5 patients, of whom tricuspid valvuloplasty was performed simultaneously in 2 patients with tricuspid regurgitatiorL The aortic cross-clamping time was （55. 6±8. 7） min, cardiopnlmonary bypass time was （86.8±12. 9） min, artificial respiration time was （17. 8±3. 5） hours. Nitroprusside sodium, prostaglandin E and dopamine were used in the early postoperative period to 4 patients with severe pulmonary hypertension. Resuits All the 5 patients were cured and discharged, grew well and no arrhythmia or anastomotic block was found during the follow-up period of 5 months to 2. 5 years. Conclusion The treatment of supracardiac TAPVR via superior approach can afford a better exposure and easy for operating, and decrease the incidence of postoperative arrhythmia and anastomotic block.

关 键 词：心血管畸形 肺静脉 心血管外科手术 

分 类 号：R654.32[医药卫生—外科学]