大动脉调转术在婴幼儿复杂性先心病中的应用(附7例报告)  

Arterial switch operation for pediatric clinical application of complex congenital heart diseases(A review of 7 cases)

作　　者：方炜[1,2] 丁力[1,2] 王敏芳[3] 张峰[1,2] 胡英超[1,2] 陈雨青[1,2] 

机构地区：[1]安徽医科大学儿科临床学院 [2]安徽省立儿童医院心外科,合肥230051 [3]合肥工业大学校医院,230009

出　　处：《安徽医学》2012年第2期147-149,共3页Anhui Medical Journal

基　　金：安徽省临床医学重点学科新技术引进项目(计划编号2008N013)

摘　　要：目的总结大动脉转位术(ASO)治疗完全型大动脉转位(D-TGA)和右心室双出口伴肺动脉瓣下室间隔缺损(Taussig-Bing)的临床经验。方法 2007年10月至2010年10月共对7例患儿行ASO,4例冠状动脉正常分布、2例左单根冠状动脉、1例右冠状动脉起源左前降支,6例用"活板门"、1例用"凸窗"技术。中或深低温、中-高流量转流,转流时间213～269 min(230.3±19.5),主动脉阻断106～188 min(147.3±28.0)。结果死亡1例(D-TGA/IVS)。存活6例,呼吸机支持(101.0±130.0)min,重症监护(8.2±6.5)d,术后住院(20.2±13.1)d。随访1～5次,时限5～59个月,发绀消失,活动能力明显增强,生长发育良好。除1例D-TGA/VSD术前ECHO提示肺动脉关闭不全、裂隙,术后复查主动脉有轻度反流外,其余无残余分流、无残余梗阻。结论 ASO已广泛应用于D-TGA和Taussig-Bing的外科手术纠治,效果大多满意。手术时的年龄、肺动脉高压、冠状动脉走行、冠状动脉移植等是手术成功的关键。Objective To Summarize the clinical experience of the arterial switch operation（ASO） for D-Transposition of the great arteries（D-TGA） and Taussig-Bing anomaly（TBA）.Methods 7 patients were underwent arterial switch operation between October 2007 and October 2010.Among the 7 patients 1 suffered from TGA with intact ventricular septum,4 from TGA with ventricular septal defect（VSD）,2 Taussig-Bing anomaly were complicated by atrial septal defect（ASD） and ventricular septal defect（VSD）.The open trap door technique was applied to 6 patients and bay window technique was applied to the rest.The operation was performed under general anesthesia and extracorporeal circulation with low temperature and low volume blood flow.Results 1 patient died of TGA with intact ventricular septum（D-TGA/IVS）.6 patients discharged from hospital with the mechanical ventilation time（101.0±130.0）min,the length of the CICU stay（8.2±6.5）d and the hospital stay（20.2±13.1）d.Follow-up results of 5 to 59 months showed no death.Cyanosis was significantly reduced,physical activities increased obviously.There was 1 patient of TGA with intact ventricular septum（D-TGA/IVS） suffered from mild aortic regurgitation,others were no residual obstruction and no residual regurgitation.Conclusion Arterial switch operation has achieved good short and long term efficient,satisfactory result can be acquired in patients who suffered from the TGA and Taussig-Bing.Operation age,pulmonary hypertension,coronary artery pattern and coronary artery transplantation were significant.

关 键 词：大动脉调转术 大动脉转位 TAUSSIG-BING畸形 先天性 

分 类 号：R726.5[医药卫生—儿科]