首次心脏手术遗漏部分性肺静脉异位引流再次外科手术临床分析  

Clinical analysis of re-operative management for residual partial anomalous pulmonary venous connection after previous cardiac surgery

作　　者：穆纯杰 王强[2] 欧阳文斌[2] 宋怡 曹宁 潘湘斌[2] 马润伟 Mu Chunjie;Wang Qiang;Ouyang Wenbin;Song Yi;Cao Ning;Pan Xiangbin;Ma Runwei(Department of Cardiac Surgery,Fu Wai Yunnan Cardiovascular Hospital,Kunming 650032,China;Department of Cardiovascular Surgery,Fu Wai Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,National Center for Cardiovascular Diseases,Beijing 100037,China)

机构地区：[1]云南省阜外心血管病医院心脏外科,昆明650032 [2]中国医学科学院,北京协和医学院,国家心血管病中心,阜外医院心脏外科,北京100037

出　　处：《中华医学杂志》2021年第4期271-275,共5页National Medical Journal of China

摘　　要：目的分析首次心脏手术遗漏部分性肺静脉异位引流(PAPVC)的原因,总结二次矫治手术的诊治策略和经验。方法回顾性分析2009年6月至2019年5月就诊于中国医学科学院阜外医院及云南省阜外心血管病医院需再次行心脏外科手术矫治PAPVC的患者临床资料,归纳该组患者术前、术中基本情况及术后并发症发生情况。结果共纳入18例患者,男7例,女11例;年龄1~49岁,中位年龄4.5岁。首次心脏手术中,3例术前确诊PAPVC,术后仍然存在;1例术前诊断为完全性肺静脉异位引流(TAPVC),术后遗留PAPVC;其余14例术前术中均漏诊。首次手术后,患者多无明显症状(11/18),11例均因术后心脏杂音或复查经胸超声心动图(TTE)发现PAPVC。二次手术中,Bordy分型A型4例,B型10例,C型2例,无D型,混合型2例,TTE对其诊断准确率为50.0%,而CT血管造影(CTA)准确率达92.9%。二次手术后无死亡病例,4例患者出现肺静脉闭塞、心包积液及吻合口狭窄等不同并发症。结论术前未明确患者心脏结构畸形以及术中未仔细探查是造成PAPVC漏诊的主要原因,TTE诊断PAPVC简便易行,联合CTA检查可提高诊断准确率。Objectives To analyze the reasons of residual partial anomalous pulmonary venous connection(PAPVC)after previous cardiac surgery,and summarize the strategies and experience for diagnosis and treatment of secondary correction operation.Methods The clinical data of 18 patients who were admitted to Fuwai Hospital of Chinese Academy of Medical Sciences and Fuwai Yunnan Cardiovascular Hospital from June 2009 to May 2019 were retrospectively analyzed.All the patients underwent secondary cardiac surgery to treat PAPVC.The preoperative and intraoperative characteristics and postoperative complications of the patients were summarized and analyzed.Results Totally,there were 7 male and 11 female cases,aged 1-49 years(median age:4.5 years).In the first cardiac surgery,3 patients were diagnosed with PAPVC,which existed after surgery.One patient was diagnosed with total anomalous pulmonary venous connection(TAPVC),but left PAPVC after surgery.The remaining 14 patients were all missed preoperative and intraoperative diagnosis.After the initial surgery,most patients had no significant symptoms(11/18),but PAPVC was found in 11 cases due to postoperative cardiac murmur or transthoracic echocardiography(TTE).In the secondary surgery,there were 4 cases of type A,10 cases of type B,2 cases of type C,no type D,and 2 cases of mixed type,respectively,according to Bordy classification.The diagnostic accuracy of TTE and CT angiography(CTA)was 50.0%and 92.9%,respectively.There was no death after the second surgery,but pulmonary vein occlusion,pericardial effusion,anastomotic stenosis and other complications occurred in 4 patients.Conclusions The main causes of missed diagnosis of PAPVC are the undefined cardiac structural deformities before operation and the lack of careful exploration during the operation.TTE is simple and feasible to diagnose PAPVC,and it can improve the diagnostic accuracy when combined with CTA.

关 键 词：心脏外科手术 肺静脉异位引流 漏诊 

分 类 号：R654.2[医药卫生—外科学]