全腔静脉肺动脉连接术的疗效与术式评价

Surgical results of total cavopulmonary connection

目的探讨全腔静脉肺动脉连接术(TCPC)的外科治疗效果并对相关术式进行评价。方法1998年2月至2006年6月,对51例复杂先天性心脏病病儿采用 TCPC 予以纠治,15例采用心内隧道术式、29例采用心外管道术式、7例采用主肺动脉与下腔静脉直接吻合术式。结果手术死亡4例(7.8%)。此外,术后低心排出量综合征6例(12.8%)、心律失常14例(29.8%)。80.1%术后24 h 内撤离呼吸机。术后48.9%留置胸引流管超过7 d。随访1个月至8年,9例(19.1%)术后6个月后仍需长期或间断服用强心、利尿剂,7例(14.7%)有房性心律失常。结论全腔静脉肺动脉连接术可取得满意的外科治疗效果。应用主肺动脉下腔静脉直接吻合术式,在部分病例中可望成为理想术式。

Objective To evaluate the surgical results of total eavopulmonary connection （TCPC）. Methods Between February 1998 and June 2006, fifty-one patients with complex congenital heart disease underwent TCPC. The procedures included lateral tummel TCPC in 15 patients, extracadiac conduit TCPC in 29 and direct anastomosis between main pulmonary artery and inferior venacava TCPC in 7. Results There were fonr operative deaths with hospital mortality of 7.8%. There were 6 patients having low cardiac output syndrome （ 12.8% ）, 14 patients having atrial arrhythmia （29.8%）. 80.1% of patients were extubated within 24 hours postoperatively. Prolonged pleural effusions, defined as more than 7 days of drainage, occurred in 48.9% patients. Follow-up ranged from 1 month to 8 years, with 9 patients （ 19.1% ） needed for medication, seven patients （ 14.7% ） had atrial arrhythmia. Conclusion TCPC may have a satisfactory surgical result. Direct anastomosis between main pulmonary artery and inferior vena-cava TCPC may be an ideal procedure for some selected patients.