全肺静脉异位引流18例外科治疗体会

Surgical treatment for total anomalous pulmonary venous drainage:report of 18 cases

目的:总结全肺静脉异位引流(total anomalous pulmonary venous drainage,TAPVD)治疗的经验。方法:在全身麻醉、低温、体外循环下对18例TAPVD患儿行矫治手术,其中8例心上型采用左心房顶部入路。结果:痊愈15例,术后早期病死3例,病死率为16.7%。延迟关胸2例。心律失常4例,均经治疗痊愈。痊愈患儿随访4～48个月,心功能正常。结论:TAPVD手术治疗成功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 in treatment of total anomalous pulmonary venous drainage（TAPVD）. Methods： Eighteen cases received surgical correction of TAPVD under hypothermia and cardiopulmonary bypass. Eight supracardiac patients were operated on through the top approach of left atrium. Results：Fiteen patients survived. Early mortality occurred in 3 cases （ 16.7% ） , delayed wound closure after surgery in 2 cases and arrhythmia in 4 cases. All of them recovered uneventfully. The cardiac function returned to normal in all the 15 cases during the follow-up term of 4 to 48 months. Conclusions ：The key to successful operation lies on enough anastomotic orifice and avoidance of anastomotie stenosis.