31例完全性肺静脉异位连接的外科治疗

A summary of surgical treatment of 31 cases with total anomalous pulmonary venous connection

目的探讨31例完全性肺静脉异位连接的手术方法及术后疗效。方法31例患者(心上型16例、心内型13例、混合型2例)均在体外循环下行矫治术。心上型6例采用传统双心房联合切口,10例采用心上法,后者经上腔静脉与升主动脉之间显露左心房与共同肺静脉干行侧—侧吻合;心内型切开房间隔缺损与冠状静脉窦开口之间的残余房间隔壁,自体心包将肺静脉开口与冠状静脉窦口隔入左房;混合型则根据不同的病理解剖特点行相应的矫治术。结果早期死亡2例,其他患者都痊愈出院。术后随访3个月至14年,恢复良好,无吻合口狭窄发生,心功能均为Ⅰ级,无因心肺功能衰竭死亡患者。结论完全性肺静脉异位连接早期诊断和及早行矫治术极为重要,手术治疗的关键在于左心房与肺总静脉吻合口应足够大,避免狭窄的发生。

Objective To summarize the experience of surgical treatment of thirty-one cases with total anomalous venous connection. Methods Thirty-one cases underwent surgical correction under cardiopulmanary bypass. Site of connection was supercardiac was （16/31）,cardiac （13/31）,and mixed （2/31）. Six of the supercardiac type of TAPVC were corrected by left atrium associate with right atrium approach. Ten of them were corrected by the superior approach. The latter approach is that the top of the left atrium and the common pulmonary venous trunk were exposed through the place between superior vena cava and ascending part of aorta and anastomosis between them was done. In intracardiac type of TAPVC the atrial septal defects were enlarged and common veins were boarded to the left atria with pericardial patches. Mixed type were corrected according to different connection. Results There was two deaths directly related to the operation. According to follow-up data of 3 months to 14 years,there was no anastomotic stenosis and death cases for heart failure and respiratory failure after discharge. Conclusion Early diagnosis and surgical correction is critical for the cases with TAPVC. The success of operation depends on the bigger enough anastomotic orifice and avoidance the anastomotic stenosis.