完全性大动脉转位手术前诊断和治疗的临床分析

A Retrospective Study on the Preoperative Diagnosis and Treatment of Complete Transposition of Great Arteries(D-TGA)

目的探讨完全性大动脉转位（D-TGA）的术前诊断、治疗及手术预后。方法回顾性分析经过超声心动图和/或心血管造影明确诊断,并予球囊房隔造口术（BAS）和/或外科手术治疗的41例D-TGA病例的临床资料。结果所有病例均经心超检查确诊为D-TGA,27例术前经心血管造影检查,其中显示分别在左、右肺动脉分叉处及各级分支有不同程度的狭窄者5例,右冠状动脉走行异常、双侧动脉导管未闭、主动脉弓降部狭窄各1例,心超未能显示。7例患儿术前经BAS,术后精神反应好转,紫绀减轻,SPO2从50%~70%上升至80%以上。30例患儿接受外科手术治疗,在21例接受大动脉转位手术治疗死亡的12例中,5例存在冠状动脉畸形,术后心肌供血不足,占41.7%。结论（1）超声心动图与心血管造影有机结合可提供全面准确可靠的信息,提高手术成功率。（2）对室间隔完整的D-TGA（TGA/IVS）危重患儿尽早进行BAS可明显改善低氧血症及代谢性酸中毒,为进一步外科手术争取时间。（3）冠状动脉的畸形是大动脉转位手术的高风险因素之一,术前充分了解冠状动脉的情况,对改善预后有一定帮助。

Objective To investigate the pre-operative diagnosis, treatment and prognosis of the pediatric patients with D-TGA. Methods Forty one cases of D-TGA diagnose with Ultrasound echocardiography（UCG） were analyzed retrospectively. Cardiovascular angiography was performed on 27 patients undergone balloon atrial septostomy （BAS）. Results All patients could be diagnosed to suffer from D-TGA by UCG, but associated abnormalities were found by angiocardigraphy effectively, which were not revealed by UCG just as follows： five cases with stenosis in the branches of pulmonary arteries, one case with abnormal course of right coronary artery, one case with coarctation of aorta and one case with double sides of patent ductus arteriosus. The clinical status of the patients undergoing BSA got better , and cyanosis relieved apparently. The SpO-2 before and after the intervention was 50 % to 70 % and 80 % , respectively. Twenty one patients were performed exchanging great arteries operation, among them, 12 patients died and abnormality coronary arteries was revealed in 5 patients amony these 12. Conclusion （1） When combined with UCG and angiocardiograply , it can provid accurate information to improve operation achievement ratio; （2） BSA , which should be operated immediately on the D-TGA patients with complete IVS, can overcome hypoxemia and metabolic acidosis ap- parently, such intervention makes it possible for the patient＇s further surgery treatment. （3） Deformations of coronary arteries which was one of the high risk factors of surgery procedure should be revealed pre-operation, in order to improve the prognosis.