大动脉转换术113例的手术结果分析

Analysis surgical results of 113 patients with complete transposition of the great arteries

目的回顾性分析大动脉转换术的手术疗效。方法 2001年1月至2005年12月,采用大动脉转换术纠治完伞性大动脉错位113例,其中室间隔完整型大动脉错位(TGA/IVS)60例,伴室间隔缺损大动脉错位(TGA/VSD)53例。患儿体重最轻2.3 kg,年龄最小出生后6 h。在深低温停循环和低流量下行大动脉转换术。结果手术总死亡率9.7%,其中 TGA/IVS 死亡5例,手术死亡率8.3%,TGA/VSD 死亡6例,手术死亡率11.3%。随着手术方法的不断改进和围手术期以及体外循环转流技术的提高,其手术死亡率不断下降,从早期的手术死亡率16.6%降至目前的5.6%。结论冠状动脉畸形是导致大动脉转换术死亡的关键,TGA/VSD 的冠状动脉畸形发生率较 TGA/IVS 要高。主动脉和肺动脉的位置并不影响手术成功率。左心室与有心室压力比例<0.6时,不能行大动脉转换术,否则术后将出现严重左心室低心排。

Objective To review and analysis the surgical results of 113 arteries Switch operations. Methods One hundred and thirteen patients had been repaired by arterial Switch operation from January 2001 to December 2005. There were 60 patients with transposition of the great arteries and intact ventricular septum （TGA/IVS）, 53 patients with transposition of great arteries and ventricular septal defect （TGA/ VSD）. The lowest body weight was 2. 3 kg, and the youngest operative age was 6 h. The arteries Switch operation was performed underwent deep hypothermic circulation arrest and low-flow perfusion. Results The total mortality was 9. 7%. There were 5 deaths among TGA/IVS （8. 3% ）, 6 deaths among TGA/VSD （11.3% ）. Following improvement of surgical technique, post-operative management and cardiopulmonary bypass , the operative mortality was decreased from 16.6% to 5.5%. Conclusions The main reason for operative mortality was abnormal coronary arteries. The incidence of abnormal coronary arteries was high at TGA/VSD. The surgical results was not infected by the position of great arteries. The low cardiac output was appeared if the ratio of left ventricular pressure and right ventricular pressure less than 0.6.