两种手术路径矫治新生儿心上型完全性肺静脉异位引流的效果评价  

Two surgical approaches for treatment of supracardiac total anomalous pulmaln⁃ry venous connection in neonates

作　　者：王刚[1] 周更须 王辉[1] 蒙强 宋林宏 Wang Gang;Zhou Gengxu;Wang Hui;Meng Qiang;Song Linhong(Department of Cardiac Surgery,The Seventh Medical Center of PLA General Hospital,Beijing100700,China)

机构地区：[1]解放军总医院第七医学中心儿童心脏外科,北京100700

出　　处：《中国体外循环杂志》2021年第6期343-346,共4页Chinese Journal of Extracorporeal Circulation

摘　　要：目的对比观察改良心包斜窦路径和心房顶路径矫治新生儿心上型完全性肺静脉异位引流的临床效果和手术经验。方法回顾性分析2014年1月至2020年1月在解放军总医院第七医学中心儿童心脏科行心上型完全性肺静脉异位引流矫治手术的32例新生儿的临床资料。其中男22例,女10例;手术中位年龄11(2,26)d;手术中位体质量3.1(2.5,4.3)kg。根据手术路径将患儿分为两组:改良心包斜窦路径组17例,心房顶路径组15例。比较两组患儿手术治疗效果。结果两组体外循环时间和主动脉阻断时间差异无统计学意义(P>0.05)。全组术后早期死亡4例(死亡率12.5%),改良心包斜窦路径组术后早期死亡率(5.9%,1/17)低于心房顶路径组(20.0%,3/15),两组差异有统计学意义(P<0.05)。中位随访时间22(6,70)月,随访期间发生肺静脉梗阻2例,2例均为心房顶路径组患儿。结论改良心包斜窦路径矫治新生儿心上型完全性肺静脉异位引流可获得良好的术野显露,与心房顶路径相比,可有效的降低手术死亡率和术后肺静脉梗阻的发生率。Objective To compare the postoperative outcomes of surgical treatment of supracardiac total anomalous pulmalnry venous connection(TAPVC)in neonates via modified oblique pericardial sinus approach and superior approach.Methods From Jan⁃uary 2014 to January 2020,32 neonates with supracardiac total anomalous pulmonary venous connection who underwent surgical repair were included in this study.There were 22 males and 10 females with the median age of 11(2,26)days and the median body weight of 3.1(2.5,4.3)kg.Patients were divided into two groups:modified oblique pericardial sinus approach group(17 patients)and superior approach group(15 patients).The effects of surgical treatment were compared between the two groups.Results There was no significant difference in the cardiopulmonary bypass time and aortic cross-clamp time between the two groups(P>0.05).4 cases died early after operation(12.5%).The early postoperative mortality in the modified oblique pericardial sinus approach group(5.9%,1/17)was signifi⁃cantly lower than that in the superior approach group(20.0%,3/15)(P=0.000).The patients were followed up for 22(6-70)months.Postoperative pulmonary venous obstruction(PPVO)occurred in 2 patients in the superior approach group.There was no PPVO in the modified oblique pericardial sinus approach group.Conclusion To correct the supracardiac TAPVC in neonate,it can provide a wide and clear operation field via modified oblique pericardial sinus approach.Compared with superior approach,modified oblique pericardial sinus approach can effectively decrease the mortality of surgical repair for TAPVC and the incidence of PPVO.

关 键 词：完全性肺静脉异位引流 新生儿 心脏手术 切口入路 

分 类 号：R722.1[医药卫生—儿科]