新生儿完全性肺静脉异位连接的解剖多样性及外科治疗  

Anatomic diversity and efficacy analysis of total anomalous pulmonary venous connection in neonates

作　　者：黄景思[1] 刘琴[1] 邹鹏[1] 许伟滨[1] 饶姣 孙善权[1] Huang Jingsi;Liu Qin;Zou Peng;Xu Weibing;Rao Jiao;Sun Shanquan(Department of the Cardiac Center,Guangdong Women and Children Hospital,Guangzhou 511442,China)

机构地区：[1]广东省妇幼保健院心脏中心,广州511442

出　　处：《中华解剖与临床杂志》2021年第3期326-332,共7页Chinese Journal of Anatomy and Clinics

摘　　要：目的总结新生儿完全性肺静脉异位连接(TAPVC)的解剖多样性及外科治疗的方法与疗效。方法回顾性分析2010年11月—2017年7月广东省妇幼保健院收治的59例新生儿TAPVC的临床资料,其中男44例、女15例,年龄1~29 d(中位数10 d),体质量2.0~4.5 kg(中位数3.23 kg)。TAPVC根据Darling分型:心上型26例,心内型12例,心下型17例,混合型4例。53例患儿存在不同程度的肺静脉回流受限:垂直静脉梗阻35例,限制型房间隔交通51例。35例因呼吸循环功能衰竭予呼吸机辅助治疗,行急诊或亚急诊手术;24例患儿行择期手术。59例患儿中,心上型、心下型及混合型共45例采用改良肺静脉共同腔与左心房切口、内膜对内膜的外翻缝合技术,12例心内型采用切除卵圆瓣及冠状静脉窦-左房间壁、心包片重建房间隔的方法,2例肺静脉共同腔细小(心上型、心下型各1例)采用Sutureless技术吻合。术后定期随访,观察患儿临床症状及生长发育情况,以及术后肺静脉梗阻、心功能不全等并发症情况;并行心脏超声检查,观察吻合口血流速度及心功能情况。结果59例患儿中,15例延迟关胸,其余患儿均顺利完成手术。59例患儿体外循环44~454 min(中位数97 min),主动脉阻断20~167 min(中位数35 min),辅助循环14~182 min(中位数38 min)。术中出血量40~90 mL(平均60 mL)。59例患儿住院11~75 d(中位数24 d),机械通气时间2~35 d(中位数5 min)。术后低心排血量综合征21例,腹膜透析15例。术后死亡3例:1例心下型TAPVC合并左房三房心及左肺静脉发育不良患儿,术后死于心包填塞;1例心下型TAPVC患儿和1例心上型TAPVC患儿,因先天性支气管肺发育不良,叶、段支气管狭窄软化,反复呼吸道感染死亡。56例患儿术后心肺功能稳定后顺利撤除呼吸机,伤口愈合良好,出院后随访31~112个月,平均57个月。随访期间3例患儿术后3个月~2年出现肺静脉梗阻,均暂未再次手术干预;其余53例Objective To summarize the anatomical variations and surgical experience of total anomalous pulmonary venous connection(TAPVC)in neonates.Methods From November 2010 to July 2017,59 cases of neonatal TAPVC who received surgical treatment in our department were reviewed.The patients were aged from 1 day to 29 days with a body weight of 2.0 to 4.5 kg.According to Darling classification,26 cases were supracardiac,12 cases were intracardiac,17 cases were infracardiac,4 cases were mixed.Thirty-five patients had used respirator-assisted ventilation and received emergency or sub emergency surgery because of respiratory failure.Fifty-three cases of pulmonary venous insufficiency with different levels,35 cases of vertical vein obstruction,and 51 cases of restricted atrial septal traffic were observed.Thirty-five cases were treated with a ventilator because of respiratory and circulatory failure,and underwent emergency or sub emergency surgery.Twenty-four children underwent elective surgery.Forty-five patients with cardiac type,subcardiac type,and mixed type were treated with modified pulmonary vein joint vena cava and left atrium incision,and intima-to-intima eversion suture technique.In 12 patients with intracardiac type treated with the method where the valves of the foramen ovale and the left atrium wall of the coronary sinus were removed,the atrial septum was reconstructed with a pericardium patch.Two cases were treated with sutureless technology due to small common pulmonary vein.The clinical symptoms,growth,and development of the children were observed with regular follow up after surgery.Cardiac ultrasonography was performed to observe the cardiac function and blood flow velocity at the anastomotic site.Postoperative complications such as pulmonary vein obstruction and cardiac insufficiency were also observed.Results Among the 59 cases,15 cases delayed chest closure,and the rest completed the operation successfully.The median time of cardiopulmonary bypass was 97(44-454)min,the median time of aortic cross-clamp was

关 键 词：血管畸形 婴儿 新生 心脏病 完全性肺静脉异位连接 肺静脉梗阻 解剖变异 外科治疗 

分 类 号：R726.5[医药卫生—儿科]