右心旁路手术治疗复杂先天性心脏病

The Result of Right Heart Bypass Operation for Treating Complex Congenital Heart Disease

目的总结右心旁路手术治疗复杂先天性心脏病的临床经验。方法2004年10月至2008年1月,采用右心旁路手术治疗复杂先天性心脏病共24例(病种包括三尖瓣闭锁、单心室等,其中心脏位置异常8例)。19例行双向格林术,5例行全腔静脉-肺动脉吻合术。24中16例在非体外循环下实施,2例双向格林术术后再次手术。结果全组手术死亡1例(4.2%),乳糜胸及低氧血症各1例。结论①右心旁路手术治疗复杂先天性心脏病分期手术效果好,但手术难度增加;②全腔静脉-肺动脉吻合术,外管道与右心房开窗效果较好;③技术达标后可尝试非体外下手术,但体外循环必须有良好的应急能力。

OBJECTIVE To evaluate the result of right heart bypass operation（RHB） for treating complex congenital heart disease. METHODS From October 2004 to January 2008, 24 patients with complex congenital heart disease underwent RHB. The dignoses of patients included tricuspid atresia, single ventricle, and so on. Among them, 8 cases were found ectopia cordis. Opreation precedure included bidrectional Glenn shunt （19 cases） and total caval pulmonary connection （TCPC,5 cases）. In the 24 cases, 16 patient underwent off - pump operation. RESULTS Total hospital mottality was 4.2%. Postoperative complications included chylothorax （ 1 case） and hypoxemia （ 1 case）. CONCLUSION 1. RHB with staging operation has good effect for complex congenital heart disease with increased operation difficulty ; 2. The effect of extracardiac conduit operation with windowing operation is better in TCPC ; 3. RHB with off - pump technique is a useful procedure in the early management. It is easy to perform.