双向腔静脉肺动脉吻合术治疗肺血减少型复杂先天性心脏病

Surgical Treatment of Complex Congenital Heart Diseases With Inadequate Pulmonary Blood Flow by Bidirectional Cavopulmonary Anastomosis

目的:总结双向腔静脉肺动脉吻合术(BCPA)治疗肺血减少型复杂先天性心脏病(先心病)的经验。方法:2004-01至2007-12,对49例肺血减少型复杂先心病患者行BCPA手术。28例于体外循环下手术,21例于非体外循环下手术。手术方式:单侧BCPA37例,双侧BCPA10例,半房坦(Fontan)术2例。同期合并手术包括:房室瓣修复术6例,肺动脉重建术1例,动脉导管未闭结扎术1例。结果:全组无手术死亡。术后早期并发症:乳糜胸1例,切口感染1例。术后动脉血氧饱和度0.89±0.03。无中晚期并发症。全组患者随访2～48个月,平均(13.07±9.85)个月。最后1次随访结果:活动量明显改善,心功能(NYHA)Ⅰ～Ⅱ级。心脏彩色超声心动图:腔静脉肺动脉吻合口血流通畅。2例分别于术后第2年、第3年改行全腔静脉肺动脉吻合术。结论:BCPA术治疗难以解剖根治或Ⅰ期生理矫治的肺血减少型复杂先心病能明显改善紫绀,缓解症状,但有其适应证。

Objective ： To summarize the experience of surgical treatment of complex congenital heart diseases （ CHD ） with inadequate pulmonary blood flow by bidirectional cavopulmonary anastomosis （BCPA）. Methods ： Forty nine complex CHD patients with inadequate pulmonary blood flow admitted in our hospital from January 2004 to December 2007 who underwent BCPA were enrolled in this study. 28 patients had the operation with the cardiopulmonary bypass and 21 without. 37 patients underwent unilateral BCPA, 10 bilateral BCPA, 2 hemi-Fontan procedure. Concomitant procedures included atrioventricular valve repair （6 cases）, pulmonary artery reconstruction （1 case） and closure of patent ductus ar- teriosus （1 case）. Results： There was no operative death. The early post-operative complications included ehylothorax （ 1 Case） and incision infection （ 1 Case ）. The mean oxygen saturation increased from（ 0. 72 ± 0. 08 ）to（ 0. 89 ±0. 03 ）. No late post-operative complications were observed. The mean follow up time was （ 13. 07 ±9. 85 ）months. The follow up results indicated that the patients＇ cardiac function reached Ⅰ -Ⅱ by NYHA classification and the patients＇ daily activity was significantly improved. The echo cardiogram showed good blood flow in anastomosis. 2 patients underwent the total cavopulmonary anastomosis 2 and 3 years after BCPA respectively. Conclusion ： BCPA was an effective treatment for complex CHD with inadequate pulmonary blood flow that can not be corrected anatomically nor physiologically. The patients should be applicable.