完全性肺静脉异位连接的外科治疗  

Surgical Repair of Total Anomalous Pulmonary Venous Connection

作　　者：董松波[1] 范顺阳[1] 李斌[1] 裴宇[1] 杨玉齐[1] 范太兵[1] 

机构地区：[1]郑州大学第三附属医院心外科,郑州450000

出　　处：《实用儿科临床杂志》2010年第23期1796-1797,1830,共3页Journal of Applied Clinical Pediatrics

摘　　要：目的探讨完全性肺静脉异位连接(TAPVC)的手术治疗方法。方法 2003年2月-2008年7月本院共诊治TAPVC患儿30例。男17例,女13例;手术年龄31d～7岁[(11.31±16.22)个月];体质量2.5～21.0kg[(6.47±3.53)kg]。心上型11例(36.67%),心内型16例(53.33%),心下型1例(3.33%),混合型2例(6.67%)。并动脉导管未闭(PDA)5例,肺动脉瓣狭窄2例,PDA并部分性房室通道1例。手术分别在中度低温体外循环、深低温停循环下进行。心上型均采用肺静脉共汇和左房顶部直接吻合法。结果手术早期死亡2例(病死率6.67%),远期死亡2例。术后发生并发症11例(36.67%)。其中结性心律3例,房性期前收缩5例,肺部感染1例,拔管后再插管2例,均治愈出院。本组28例随访3个月～6a。2例死亡,其中1例心上型患儿于术后6个月死于肺炎,另1例心内型患儿6个月随访时已死亡。余患儿术后恢复均良好。结论 TAPVC一经诊断应尽早手术。对于心上型TAPVC患儿,左房上吻合法操作简便,心律失常发生率低。保持吻合口畅通及完善的术后监护可提高手术成功率。Objective To discuss the surgical repair of total anomalous pulmonary venous connection（TAPVC）. Methods From Feb. 2003 to Jul. 2008,30 patients from the Third Affiliated Hospital of Zhengzhou University （ 17 male, 13 female） were operated. The operative age was 31 days to 7 years old [ mean （ 11.31 ± 16.22 ） months ] and the weight was 2.5 -21.0 kg [ mean （6.47 ± 3.53 ） kg ]. Eleven patients belonged to the supraeardiac type, 16 cases cardiac type, 1 case infracardiac type and 2 cases mixed type. Accompanying congenital cardiac malformations were diagnosed such as patent ductus arteriosus （PDA）（ 5 cases） ,pulmonary slenos（ 2 cases）, PDA with partial atrioventricular canal（ 1 case）. All the patients underwent total correction under moderate hypothermic cardiopulmonary bypass and deep hypothermia with circulatory arrest,respectively. All the approaches of the supracardiac type was making anastomosis between the left atrium and common pulmonary vein. Results The early operative mortality was 6.67% （2/30 cases）. There were 2 cases late deaths. Complication occurred in 11 cases （ 37.67 % ）, such as nodal rhythm （ 3 cases）, atrial premature beats （5 cases）, pulmonary infection （ 1 case） and tracheal reintubation （ 2 cases）. All of them discharged after active therapy. Twenty - eight cases were followed - up from 3 months to 6 years. One case（ supracardiac type） died 6 months after surgery due to pneumonia and another（ cardiac type） died of unknown reason. The rest cases recovered well. Con- clusions TAPVC should be surgically repaired once the diagnosis is confirmed. About supracardiac type, supracardiac an astomosis is easy to operate, and the arrhythmia incidence is low. The fluency of the common pulmonary vein - left atrium anastomoses and proper postoperative care can improve the success rate of operation.

关 键 词：完全性肺静脉异位连接 先天性心脏病 外科治疗 

分 类 号：R654.3[医药卫生—外科学]