改良Fontan术治疗单心室合并心尖-腔静脉并置的管道路径选择  

Route selection for modified fontan in patients with functional single ventricle and apicocaval juxtaposition

作　　者：陈伟丹[1] 马力[1] 夏园生[1] 杨盛春[1] 邹明晖[1] 崔彦芹 张明杰[1] 陈欣欣[1] 

机构地区：[1]广州医科大学附属广州市妇女儿童医疗中心心脏中心,510623

出　　处：《中华胸心血管外科杂志》2017年第9期542-545,共4页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的 总结改良Fontan术治疗单心室合并心尖-腔静脉并置管道路径的选择和临床疗效.方法 2011年1月至2016年4月,31例功能性单心室合并心尖-腔静脉并置患儿行改良Fontan术,手术年龄16个月～14岁,平均（58.5±32.4）个月;体质量9.1～ 40.3 kg,平均（16.2±6.0） kg.合并完全性房室间隔缺损9例,完全性肺静脉异位引流8例,右心房异构7例,中度以上房室瓣反流4例,肝静脉异常回流4例.结果 心外管道与同侧肺动脉端侧吻合的24例,与对侧肺动脉端侧吻合的5例,选择心房内外管道技术与对侧肺动脉连接的2例.术后患者末梢血氧饱和度0.90±0.06,持续性胸腔积液5例.1例因严重感染死亡,30例顺利出院.随访1～65个月,平均（17.5±15.4）个月,患儿生长发育良好,无再次手术和死亡.结论 通过术中合理选择管道路径,改良Fontan术治疗单心室合并心尖-腔静脉并置术后早、中期效果良好.Objective We reviewed our experience with modified Fontan in patients with functional single ventricle and apicocaval juxtaposition with a special focus on route selection and outcomes.Methods From January 201 1 to April 2016,31 patients with functional single ventricle and apicocaval juxtaposition underwent modified Fontan procedure at our hospital.Mean age at operation was（58.5 ± 32.4） months（ranged 16 months to 14 year）,and the mean body weight was （16.2 ± 6.0） kg （range,9.1-40.3 kg）.There were right atrial isomerism 7 cases,complete atrioventricular canal defect 9 cases,≥moderate atrioventricular valve regurgitation 4 cases,total anomalous pulmonary venous connection 8 cases,and anomalous hepatic venous connection 4 cases.Fontan procedure was performed in 5 patients,bidirectional Glenn in 13,Kawashima in 3,central shunt in 1,atrioventricular valve replacement in 5,and pulmonary artery banding in 5.Results In 24 patients,the extracardiac conduit was placed between the inferior vena cava（IVC） and the ipsilateral pulmonary artery behind the ventricle.In the 5 other patients,the conduit was placed between the IVC and the contralateral pulmonary artery.In another 2 patients the tube graft was anastomosed with the contralateral pulmonary artery（intraextracardiac Fontan）.After operation,the peripheral blood oxygen saturation was 0.90 ±0.06.Five patients suffered pleural effusion,and 1 patient died of infection during hospitalization.The follow-up duration was（17.5 ± 15.4） months（1-65 months）.There was no late death and reoperation.Conclusion Modified Fontan procedure in functional single ventricle and apicocaval juxtaposition can be carried out with favorable midterm outcomes.Care must be taken in regard to critical conduit oppression by the ventricle or compression on pulmonary veins.

关 键 词：单心室 内脏异位 心尖-腔静脉并置 

分 类 号：R726.5[医药卫生—儿科]