主动脉移位术纠治完全型大动脉错位伴室间隔缺损和肺动脉狭窄的疗效观察

Outcome of aortic translocation procedure in treatment of complete transposition of great arteries with ventricular septal defect and pulmonary stenosis

目的总结主动脉移位术纠治完全型大动脉错位伴室间隔缺损和肺动脉狭窄的临床疗效。方法 2005年1月—2010年6月,采用主动脉移位术纠治完全型大动脉错位伴室间隔缺损和肺动脉狭窄的患儿21例,其中合并流入道室间隔缺损4例,合并三尖瓣骑跨3例。对患儿手术情况和随访资料进行回顾性分析,评价疗效。结果院内死亡1例;其余20例患儿中,术后发生严重低心排血量综合征1例、急性肾功能衰竭7例、急性肝损伤1例、肺部感染2例,均经积极治疗后愈合出院。随访时间为8～61个月,无死亡病例;所有患儿无远期左心室流出道梗阻和室性心律失常发生,心功能均恢复正常。结论采用主动脉移位术纠治完全型大动脉错位伴室间隔缺损和肺动脉狭窄可取得良好的远期疗效,但术后早期对心功能影响较大,需要完善的监护治疗。

Objective To investigate the outcome of aortic translocation procedure in the treatment of complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis.Methods Twenty-one patients with complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis underwent aortic translocation procedure between January 2005 and June 2010.Inlet ventricular septal defects were found in 4 patients,and straddling tricuspid valves were found in 3 patients.The operation and follow up results were retrospectively analysed,and the outcome was evaluated.Results There was 1 case of in-hospital death.Among the other 20 patients,there was 1 case of low cardiac output syndrome,7 cases of acute renal failure,1 case of acute liver injury and 2 cases of pulmonary infection after operation,and all were cured and discharged.Patients were followed up for 8 to 61 months,there was no death and no left ventricular outlet obstruction or ventricular arrhythmia during the follow up,and cardiac function recovered in all patients.Conclusion Aortic translocation procedure may yield favorable long-term outcome in treatment of complete transposition of the great arteries with ventricular septal defect and pulmonary stenosis.However,the patients have to pull through the early stage after operation and require intensive care for cardiac function.