心房内侧隧道Fontan术纠治小儿复杂先天性心脏病47例  

Application of modified Fontan procedure (total cavopulmonary anastomosis) for correction of 47 children with complicated congenital heart diseases

作　　者：曹鼎方[1] 苏肇伉[1] 丁文祥[1] 

机构地区：[1]上海第二医科大学附属新华医院上海儿童医学中心小儿心胸外科,200127

出　　处：《中华胸心血管外科杂志》2001年第2期65-67,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　总结应用心房内侧隧道Fontan术治疗 47例小儿复杂先天性心脏病 (先心病 )的经验。方法　 47例病儿年龄 1岁 5个月～ 14岁 ;体重 9～ 42kg。病种包括三尖瓣闭锁 10例 ,单心室 17例 ,右室双出口 14例 ,完全性大动脉转位 2例和纠正性大动脉转位 4例。结果　术后早期死亡 9例 ,手术死亡率 19 1%。 1995年前手术死亡率 2 6 3%(5 / 19例 ) ,1995年后 (含 1995年 ) 14 3%(4 / 2 8例 )。晚期死亡1例。结论　改良Fontan术适应证已扩大至许多解剖上不能纠治、功能上仅有一个单心室腔的复杂性紫绀型先心病 ,为提高手术疗效须严格掌握手术适应证 ;板障上开窗可有效降低腔静脉和右房压力 ,减少胸腔引流量 ,缩短住院周期 ,提高体循环心排出量 ;少数不能耐受Fontan术后循环生理改变的难治性低心输出量病儿 ,应早期果断再手术改建为双向腔肺分流术 (半Fontan术 )。Objective: To summarize experiences of application of modified Fontan procedure (total cavopulmonary anastomosis) for correction of complicated congenital heart diseases in 47 children. Methods: 47 patients with complicated heart disease received modified Fontan procedure. Their age ranged 1 4～14 0 years. The body weight was 9～42 kg. The heart anomalies included tricuspid atresia in 10 patients, single ventricle in 17, double outlet of right ventricle in 14, transposition of the great arteries in 2 and corrected transposition of the great arteries in 4. Results: The operative mortality rate was 19 1%(9/47). Before 1995, the mortality was 26 3%(5/19), and after 1995 (including 1995) was 14 3%(4/28). One case died lately. Conclusion: The indication of modified Fontan procedure is widely extended including a variety of cyanotic complicated congenital heart diseases with only a single functional ventricular chamber in corrigible anatomically. To improve the operative results, the indication must be strictly considered. A baffle fenestration will lower caval and right atrial pressure, decrease pleural drainage, Shorten hospital stay and maintain cardiac output. For patients with refractory low cardiac output after Fontan circulation, an early and prompt reoperation to convert the circulation to a bidirectional cavopulmonary shunt (hemi Fontan procedure) should be considered.

关 键 词：先天性心脏缺损 心脏外科手术 FONTAN手术 儿童 

分 类 号：R726[医药卫生—儿科]