先天性心脏病合并永存左上腔静脉的临床分析

Diagnosis and surgical treatment of persistent left superior vena cava combined with congenital heart diseases

目的:探讨先天性心脏病合并左上腔静脉(PLSVC)畸形对心脏外科手术的影响及手术对策。方法:对我院2000年以来1921例不同类型的先天性心脏病的临床资料进行统计分析。结果:发现PLSVC 46例,发生率2.4%,其中简单先心病伴发PLSVC者33例(2.0%,33/1650),复杂先心病伴发PLSVC者13例(5.5%,13/238),P<0.01; 总漏诊率37%,简单先心病伴发者漏诊率21%,复杂先心病伴发者漏诊率77%,二者差异非常显著(P<0.01);复杂先心合并PLSVC的6例均有I孔房缺,且二项logistic分析显示合并ASD畸形及先心病复杂程度是合并PLSVC的危险因素。除1例Fanton术后一月死于心律紊乱,全部患者均经手术治愈出院,无PLSVC相关合并症发生。结论: (1)复杂先心病的PLSVC发病率及漏诊率均显著高于简单先心病伴PLSVC者;(2)复杂先心病、ASD畸形是合并PLSVC的危险因素,特别是I孔房间隔缺损。

Objective ： To investigate the influence of patent left superior vena cava （PLSVC） on surgery diagnosis and treatment. Methods： The data of 46 patients with congenital heart diseases （CHD） associated with PLSVC since 2000 were statistically analyzed. Results： A total of 46 cases were found to have PLSVC （2.4%） in 1921 CHD patients, the total lost diagnosis rate was 37%. In which PLSVC associated simple CHD occupied 2.0% （33/1650）,its lost diagnosis rate was 21%; associated complex CHD occupied 5.5% （13/238）, its lost diagnosis rate was 77% differences between two groups were very significant （P〈0. 01, all）. The binary logistic analyze shal septal defect （ASD） and class of CHD were the.risk factors. Except one case died one month later after Fanton operation, all patients recovered by operation. Conclusion： （1） The ineidenee and lost diagnosis rate in eomplex CHD assoeiated PLSVC are more than those of simple CHD assoeiated PLXVC; （2） The ASD and eomplex elass of CHD are signifieant risk faetors of PLSVC.