先天性心脏病合并其他系统畸形联合同期矫治手术的效果分析  

Analysis of combined operations for congenital heart disease and other malformation

作　　者：魏丹[1] 张辉[1] 李龙[1] 吴涛[1] 秦广宁[1] 罗毅[1] WEI Dan ZHANG Hui LI Long WU Tao QIN Guangning LUO Yi(Department of Cardiac Surgery, Children＇s Hospital Attached to The Capital Institute of Pacdiatrics ,Beijing100020 , China)

机构地区：[1]首都儿科研究所附属儿童医院心脏外科,100020

出　　处：《心肺血管病杂志》2017年第8期678-681,共4页Journal of Cardiovascular and Pulmonary Diseases

基　　金：北京市医院管理局临床技术创新项目(XMLX201712)

摘　　要：目的:总结我科行先天性心脏病合并其他畸形联合同期手术治疗的临床效果,探讨同期联合手术的可行性、安全性及优势,以期在临床推广联合手术方法。方法:回顾总结2015年6月至2015年12月间,在我科行先天性心脏病合并其他畸形联合同期手术的患者情况。总结联合手术时间、手术方法、术后监护室滞留时间、气管插管时间、合并手术的部位出血情况及围术期死亡率。结果:在此期间共有8例患儿行先天性心脏病合并其他畸形联合同期手术,其中男性4例,女性4性,中位年龄21(10,98)个月,平均体质量10.5(6.6,11.9)kg。先天性心脏病分别为房间隔缺损(ASD)5例,右心室双出口1例,右心室双出口合并ASD1例,动脉导管未闭合并ASD1例。合并畸形为双侧腹股沟斜疝2例,左侧腹股沟斜疝合并右侧鞘膜积液1例,右手赘生指1例,颈部肿物1例,隐睾1例,双眼霰粒肿1例,巨结肠合并气管狭窄1例。手术方式:1例ASD合并巨结肠的患儿在全身麻醉气管插管下先行ASD修补术后再行巨结肠根治加活检术,其他7例患儿均在全身麻醉气管插管下先行其他合并畸形根治术,之后在体外循环下行先天性心脏病矫治术,术后返回心脏外科术后监护室。联合手术时间170(163,233)min,先天性心脏病手术时间133(113,163)min,合并其他畸形矫治手术时间为45(31,75)min。8例患儿术后监护室滞留时间为(5.8±9.4)d。1例右心室双出口合并左斜疝、右鞘膜积液的患儿监护室滞留时间28d,原因为心功能减低及感染使其延长,与合并畸形无关。1例ASD合并巨结肠及气管狭窄患儿监护室滞留时间10d,原因为感染使其延长,与心脏手术无关。其余6例患儿术后监护室滞留时间为2(1,2)d。8例患儿术后气管插管时间为13(5,150)h。其中1例ASD合并双眼霰粒肿的患儿,因考虑到眼科手术后24h才能去除敷料,为避免患儿清醒后无法视物造成的恐惧感,我们将气管插�Objective： To summarize the effect of combined operations for congenital heart disease andother malformation,to explore the feasibility,safety and advantages of combined operation,in order to promote the combined operationmethod In clinical situation. Methods： retrospective summary on June 6,2015-December 2015 in our department who underwent combined operations of congenital heart disease and other malformation. Summarizes the operation time,surgicalmethod and postoperative care condition including endotracheal intubation time and the bleeding volume on part of combined surgery. Results： during the period,7 cases of congenital heart disease with other malformation underwent the combined operation,male 4 cases,female 4 cases. Age 21（ 10,98） mouth,body mass 10. 5（ 66,11. 9） kg. 5 cases of atrial septal defects（ ASD）,1 case of double outlet of right ventricle,1 case of double outlet of right ventricle with ASD,1 case of Patent Ductus Arteriosus（ PDA） with ASD. Combined malformation of bilateral inguinal hernia in 2 cases,left inguinal hernia with the right hydrocele in 1 case,right hand polydactylism in 1 case,neck neoplasm in 1 case,cryptorchidism in 1case,chalazion in 1 case,megacolon in1 cases. The operation was carried out under a general anaesthesia with intubation. All the combined malformation were correct before the the operation of congenital heart disease using cardiac pulmonary bypass（ CPB）. After the operation the patients were send to cardiac critical intensive care unit（ CICU）. The total operation time was 170（ 163,233） minutes,congenital heart disease surgery took 133（ 113,163） minutes,combined operation time was 45（ 31,75） minutes. All of the patients stay in CICU for 12（ 1,8） d. Among them,there was 1 case of double outlet of right ventricle with left oblique hernia and right hydrocele who had longer staying time of 28 days because of low cardiac output and infection. 1 case of ASD with Congenital aganglionic megacolon and tracheostenosis who had longer

关 键 词：先天性心脏病 联合手术 腹股沟斜疝 鞘膜积液 

分 类 号：R54[医药卫生—心血管疾病]