改良左心房上吻合法矫治心上型完全性肺静脉异常回流  

Modified supra-left atrial anastomosis for repairment of supracardiac total anomalous pulmonary venous connection

作　　者：赖锋华[1] 李韬[1] 陈凯明[1] 林世廷[1] 朱伯卫[1] 陈泽科[1] 

机构地区：[1]高州市人民医院心血管病外科,广东高州525200

出　　处：《岭南心血管病杂志》2013年第3期302-305,共4页South China Journal of Cardiovascular Diseases

摘　　要：目的总结从左心房顶部行改良左心房-共同静脉吻合(左心房上吻合法)治疗心上型完全性肺静脉异常回流(total anomalous pulmonary venous connection,TAPVC)的经验。方法 2005年1月至2011年8月高州市人民医院收治心上型TAPVC 17例,17例肺静脉均是经垂直静脉、无名静脉、右上腔静脉后回流至右心房,其中男7例,女10例,年龄中位数为1岁(40 d～24岁);体质量中位数为12.5 kg(3.1～31.0 kg),全组12例合并房间隔缺损,3例合并卵圆孔未闭,2例合并房间隔缺损及动脉导管未闭,均采用左心房上吻合法。结果手术死亡2例,1例死于低心排血量综合征;1例术后反复肺感染,死于呼吸衰竭。1例因术后急性肺水肿,二次手术重新开放垂直静脉延迟闭合治愈;2例心律失常(频发房性期前收缩),治疗一周恢复正常。无肺动脉高压危象。术后随访3个月至6年,平均3.5年,无吻合口狭窄和心律失常,发绀消失,活动耐力显著增加,生长发育良好。结论改良左心房上吻合法治疗心上型TAPVC,手术暴露好、操作简单、心律失常发生率低,术后中期随访结果良好。Objectives To summarize the experiences of modified supra-left atrial anastomosis between the left atrium roof and the pulmonary common vein for supracardiac total anomalous pulmonary venous connection （TAPVC）. Methods From January 2005 to August 2011,17 patients with supracardiac TAPVC in Gaozhou People＇s Hospital underwent surgical repair by using modified supra-left atrial anastomosis. Of the 17 cases, all the pulmonary veins were drained from vertical vein, innominate vein and right superior vena cava to the right atrium. There were 7 males and 10 females with a median age of 1 year （raging from 40 days to 24 years）. The median weight was 12.5 kg （raging from 3.1 kg to 31.0 kg）. The complications included atrial septal defect in 12 cases, patent oval foramen in 3 cases and both atrial septal defect complicated with patent ductus arteriosus in the other 2 cases. Results One patient died from low cardiac output syndrome postoperatively. One case suffered from repeated pulmonary infection and died from respiratory failure. One case was complicated with acute pulmonary edema after surgery and was cured by reopening the vertical vein and closed later. Two cases with cardiac arrhythmia were recovered after 1 week treatment. There was no pulmonary artery hypertension. The postoperative follow-up period was ranged from 3 months to 6 years （mean 3.5 years） with no narrow anastomotic stoma and arrhythmia. The symptoms of cyanosis disappeared and their activity of daily living was improved significantly. Conclusions The modified supra-left atrial anastomosis for supracardiac TAPVC can be administered easily with good exposure and simple operation technique. By using the method, there is low occurrence of arrhythmias and the intermediate term result is satisfied.

关 键 词：外科手术 心上型完全性肺静脉异常回流 治疗效果 

分 类 号：R654.2[医药卫生—外科学]