非体外循环下改良全腔静脉-肺动脉连接术  

Modified total cavopulmonary connection operation without cardiopulmonary bypass

作　　者：梅举[1] 张宝仁[1] 杨小龙[2] 丁芳宝[1] 陆方林[1] 赵枫[1] 

机构地区：[1]第二军医大学长海医院心胸外科,上海200433 [2]安徽省芜湖市皖南医学院代矶山医院胸心外科

出　　处：《中华胸心血管外科杂志》2002年第6期325-327,共3页Chinese Journal of Thoracic and Cardiovascular Surgery

摘　　要：目的　探讨非体外循环下行改良全腔静脉 -肺动脉连接手术治疗功能性单心室技术。方法　 3例功能性单心室病儿在非体外循环下施行了改良全腔静脉 -肺动脉连接手术。术中先作上、下腔静脉插管并与右房插管连接 ,静脉血分流入右房 ,然后置右肺动脉侧壁钳 ,上腔静脉远心端与右肺动脉上缘行端侧吻合 ,吻合口尽量偏左 ;下腔静脉通过心外管道与右肺动脉下缘连接 ,吻合口尽量偏右。最后缝扎肺动脉口。结果　术后无早、晚期死亡 ,仅 1例发生低心输出量综合征及胸腔渗出。动脉血氧饱和度 0 94～ 0 97。术后随访 1～ 3个月 ,心功能I级 2例 ,II级 1例。结论　非体外循环下行改良全腔静脉 -肺动脉连接术 ,是治疗功能性单心室的有效技术 ,可取得良好的手术效果。Objective: To report the modified total cavopulmonary connection (TCPC) operation without cardiopulmonary bypass for treating functional single ventricle. Methods: Modified TCPC was performed in three patients with functional single ventricle. Superior vena cava (SVC) and inferior vena cava (IVC) were cannulated and connected with right atrial cannulation to drain the systematic blood into right atrium. A side-biting clamp is used to occlude the right pulmonary artery (RPA). The distal end of SVC was connected with the upper edge of RPA with the anastomosis orifice near the left side, and the distal end of IVC was directly connected with the lower edge of RPA using extracardiac conduit. Stenosis pulmonary orifice was closed by suture. Results: There was no early and late postoperative mortality. One patient had low cardiac output syndrome and pleural effusion. The patients had SatO_2 0.94～0.97 while inspiring air postoperatively. The patients were followed up from 1 month through 3 months, and NYHA heart function class I was in 2 patients and class II in 1. Conclusion: Modified total cavopulmonary connection operation without cardiopulmonary bypass is an effective procedure to treat functional single ventricle.

关 键 词：先天性心脏病 外科手术 儿童 非体外循环 全腔静脉-肺动脉连接术 

分 类 号：R654.2[医药卫生—外科学]