心上法矫治心上型完全性肺静脉异位引流  

Superior Approach for Correction of Supracardiac Type of Total Anomalous Pulmonary Venous Connection

作　　者：龚琪[1] 谈凌凌[1] 王哲[1] 林薇[1] 徐振海[1] 吕会来[1] 

机构地区：[1]河北医科大学第四医院胸心外科,石家庄050011

出　　处：《实用儿科临床杂志》2010年第11期817-818,859,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的总结评估心上法手术治疗心上型完全性肺静脉异位引流(TAPVC)的经验。方法 2002年8月-2009年8月本院采用心上法矫治心上型TAPVC患儿23例。男16例,女7例;年龄7个月～14岁[(4.22±3.84)岁];体质量7～31kg[(14.9±6.5)kg]。患儿均经超声心动图确诊为心上型TAPVC,除动脉导管未闭外不并其他心内畸形,均在全麻低温体外循环下进行手术,经主动脉、上腔静脉之间行肺汇总静脉和左心房顶的侧侧吻合,并保证吻合口足够大,同时心包片修补房间隔缺损,结扎垂直静脉。结果心上型TAPVC患儿体外循环时间89～134min[(110±22)min],主动脉阻断61～89min[(75±13)min]。机械通气18～66h[(25.0±15.4)h],住院时间10～14d[(11.0±2.4)d]。无术后早期死亡及并发症发生,均治愈出院。随访3～36个月,患儿症状体征明显改善,美国纽约心脏协会(NYHA)心功能分级均为Ⅰ级,无心律失常和吻合口狭窄等并发症。结论采用心上法矫治TAPVC可获得足够大的吻合口,对心脏损伤小,且能降低术后心律失常等并发症的发生率。Objective To review the experience of surgical repair of supracardiac type of total anomalous pulmonary venous connection （TAPVC） by superior approach. Methods From Aug. 2002 to Aug. 2009,23 children in the Fourth Affiliated Hospital of Hebei Medical U- niversity with supracardic type of TAPVC underwent repair by superior approach, 16 cases were male and 7 cases were female. The age ranged from 7 months to 14 years [ mean （4.22 ± 3.84） years old] and weight ranged from 7 - 31 kg[ mean（ 14.9 ± 6.5 ） kg]. All children were diagnosed by echocardiography. They did not presented other associated anomalies except patent duetus arteriosus. The procedure was per- formed under cardopulmonary bypass （CPB）. The top of left atrium and pulmonary venous confluence was exposed through the inter- aortic caval space,in which a direct side - to - side anastomosis and adequated anastomotic stoma was done. Pericardium patch was used to repaired atrial septal defect and enlarge atrium. Vertical vein was ligated after the repair of TAPVC. Results The CPB time was 89 - 134 min[ （ 110 ± 22） min ], aortic cross - clamping time was 61 - 89 min [ （75 ± 13 ） rain ], artificial respiration time was 18 - 66 h [ （25.0 ± 15.4） h ]. There was no operative mortality and early complications. All children were cured and discharged. During the follow - up period of 3 to 36 months, all children had significant clinical improvement and had heart function of New York Heart Association（NYHA） class I ,and there were no anastomotic stenosis or arrhythmia observed. Conclusions Surgical repair of supracardiae type of TAPVC by superior approach can afford a better exposure and adequate anastomotic stoma with less injury,reducing the risk of arrhythmia.

关 键 词：肺静脉 心脏外科手术 心脏病 先天性 

分 类 号：R726.5[医药卫生—儿科]