完全性肺静脉异位连接的外科治疗

Surgical treatment of total anomalous pulmonary venous connection

目的 总结完全性肺静脉异位连接的外科治疗经验，以进一步提高手术成功率和远期疗效：方法 2000年1月～2005年12月，我院手术治疗完全性肺静脉异位连接患儿32例，其中心上型18例，心内型13例，心下型1例：心上型经心内法吻合12例，心上法吻合6例：心内型均扩大共同静脉至4个肺静脉开口，再以自体心包补片修补房间隔缺损。心下型采用左右心房联合切口，将左房后壁与共同静脉作侧侧吻合。结果 手术死亡1例，手术死亡率3．1％，死亡原因为低心排血量综合征，其余均顺利康复出院；随访1～68个月，1例心内型患者于术后6个月出现肺静脉回流梗阻死亡，余生长发育良好：结论 完全性肺静脉异位连接及时、正确的手术治疗可以获得良好的手术效果。

Objective To sum up the therapeutic results of 32 cases of total anomalous pulmonary venous connection （TAPVC）. Methods Between January 2000 and December 2005,32 cases of TAPVC underwent surgical treatment. The type of deformities included supercardiac （18 cases）, intracardiac （13 cases）and infracardiac TAPVC （ 1 cases）. 12 cases of supercardiac were anastomsed by intracardial method and 6 cases were anastomosed by supereardial method. The common vein in intracardiac type was amplified into 4 openings of pulmonary vein, then the atrial septal defect was repaired with self pericardial patches. The infracardiac type was performed by combined incision of left and right atrium cordis, and posterior of left atrium cordis was anastomosed with common vein by side to side pattern. Results Among 32 patients 1 patient died, The surgical mortality was 3.1%. The cause of death was serious low cardiac output syndrome, and the other patients recovered well. After follow-up of 1 - 68 months, 1 patient occurred venous return obstruction and died 6 months later, the other patients recovery, smoothly and developed well. Conclusion Early diagnosis and surgical operation are quite important for TAPVC patients. An appropriate choice of surgical method can ensure a satisfactory, outcome.