全腔静脉肺动脉连接术在复杂发绀型先心病的应用及术式选择

Different surgical procedures of total cavopulmonary connection in complex cyanotic congenital heart disease

目的:探讨不同方式的全腔静脉肺动脉连接术在复杂发绀型先天性心脏病中的选择及应用效果。方法:回顾性分析32例全腔静脉肺动脉连接术患者的临床资料:年龄5～24岁,平均(10±5)岁,体重13～55kg,平均(28±11)kg,病种包括单心室16例,右心室双出口并完全性心内膜垫缺损6例,完全性大动脉转位并完全性心内膜垫缺损3例,三尖瓣闭锁6例,二尖瓣闭锁1例。其中,在低温体外循环心脏停跳下18例行右房内侧隧道法,1例行心外管道法,常温体外循环心脏跳动下10例行心外管道法,非体外循环下2例行心外管道法,1例行分次全腔静脉肺动脉连接术。结果:早期发生双侧胸腔积液3例,窦性心动过速2例。出院时指端血氧饱和度由术前的71.5%～84.5%提升到91%～96%;心功能改善。全组随访2个月～8年,无早、晚期死亡。结论:根据患者的年龄、体重、心内畸形等不同情况有选择地应用不同方法的全腔静脉肺动脉连接术,才能获得最佳的治疗效果。

Objective：To summarize the experience of total cavopulmonary connection （TCPC） with different methods and study the operative indication,design and therapeutic efficacy. Methods： 32 patients of TCPC were reviewed： the average age was 10 years,ranged from 5 to 24 years and the average weight was 28 kilogramme,ranged from 13 to 55 kilogramme.18 patients underwent lateral tunnel and 1 patient underwent extracardiac conduit TCPC with hypothermic eardiopulmonary bypass （CPB） and heart arrest,and 10 patients were treated by extracardiac conduit technique with normothermic CPB and without heart arrest and 2 patients without CPB,and 1 patients underwent two-step operation. Results：Two-side pleural effusion occurred in 3 patients and sinus tachycardia occured in 2 patients early. The SpO2 increased from 71.5%-84.5% to 91%-96% when out of hospital and the heart function improved too. Followed up from 2 monthes to 8 years,all patients survived. Conclusion：Corresponding cardiovascular surgical procedures of TPCP should be selected strictly according to age,weigth and heart defects of patients,and it＇s the key point of obtaining the best therapeutic efficacy.