553例功能性单心室外科治疗的回顾性分析  

Retrospective analyze surgical treatment for 553 patients with functional univentricular heart

作　　者：徐志伟[1] 杜欣伟 陈浩[1] 张海波[1] 郑景浩[1] 严勤[1] 仇黎生[1] 王顺明[1] 鲁亚男[1] 朱宏斌[1] 祝忠群[1] 陈会文[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海交通大学附属上海儿童医学中心心胸外科,200127

出　　处：《中华胸心血管外科杂志》2014年第4期195-198,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 回顾性分析功能性单心室的外科治疗,以提出更合理的治疗策略.方法 2007年1月至2011年12月,共纠治功能性单心室患儿（婴）553例.男355例,女198例,年龄3个月～17岁,平均（42.87 ±31.96）个月;体质量4.5～56.0 kg,平均（13.79±10.11） kg.行一期双向腔静脉肺动脉吻合术372例,二期双向腔静脉肺动脉吻合术52例.全组行一期Fontan术129例,二期Fontan术236例,三期Fontan术11例.所有Fontan手术均采用板障开窗,直径4 mm.结果 全组37例死亡,病死率6.69％.一期双向腔静脉肺动脉吻合术死亡6例（1.61％）;二期双向腔静脉肺动脉吻合术死亡3例（5.76％）.376例Fontan手术,死亡28例,占5.88％.结论 随着Fontan手术的不断改进,功能性单心室的外科治疗成功率明显提高.但还需进一步长期随访以确立功能性单心室外科治疗的远期疗效和长期生存率.Objective To analyze the clinical experience of surgical treatment for ehildren with functional univentricular heart in recent five years in order to explore a more rational treatment strategy.Methods 553 patients with functional univentricular heart underwent surgical procedures from January 2007 to December 2011.There were 355 males and 198 females in our group,aged from 3 months to 17 years[mean,（42.87 ± 31.96） months] and weighed from 4.5 to 56.0 kg [mean,（13.79 ± 10.11） kg].Among them,one-stage bidirectional cavo-pulmonary connection were performed in 372 cases,twostage bidirectional cavo-pulmonary connection were performed in 52 cases; one-stage Fontan operations were performed in 129 cases,two-stage Fontan operations were performed in 236 cases,three-stage Fontan operations were performed in 11 cases.A 4 mm fenestration was punched in the baffle in all Fontan operations.Results There were 37 deaths in all 553 cases and the mortality rate was 6.69%.Six deaths occurred in cases undergoing one-stage bidirectional cavo-pulmonary connection and the mortality rate was 1.61%.Three deaths occurred in cases undergoing two-stage bidirectional cavo-pulmonary connection and the mortality rate was 5.76%.Twenty-eight deaths occurred in all 376 cases undergoing Fontan operations.Mortality rate of this group was 5.88%.Conclusion With technical improvement of Fontan operation,the success rate of surgical treatment for children with functional univentricular heart has been elevated obviously.Nevertheless,further long-term follow-up studies are needed to evaluate the late results and the long-term survival rate for patients who underwent the surgical procedures for functional univentricular heart.

关 键 词：心脏缺损 先天性 单心室 双向腔静脉肺动脉吻合术 FONTAN手术 

分 类 号：R726.5[医药卫生—儿科]