完全性大动脉转位的外科治疗

Surgical Treatment for Complete Transposition of the Great Areteries

目的 回顾总结我院完成4例完全性大动脉转位的复杂先天性心脏病（先心病）的临床治疗经验。方法 2004年11月～2008年1月，采用大动脉转换术（Switch手术）及心房内调转术（Senning手术）治疗完全性大动脉错位（TGA）复杂先心病4例。包括室间隔完整型（TGA—IVS）1例，伴室间隔缺损（TGA—VSD）3例，2例合并轻度肺动脉瓣狭窄。结果 无手术及术后死亡。术后随访5个月～3年，所有病例发绀症状均消失，活动能力明显增强，增长发育明显加快，体重明显增加。2例术前二尖瓣轻-中度反流，1例术后仍为轻度反流，另1例反流消失。术后无主动脉和肺动脉瓣上狭窄，1例因年龄较大术后带呼吸机62天，4例均治愈出院。结论 大动脉转换术及心房内调转术应用于完全性大动脉错位的纠治，手术效果满意。对于年龄较大患儿左室发育尚可的亦可选择大动脉转换术的手术方式。

Objective To report the experience of surgical treatment of 4 patients with complete transposition of great areteries （TGA）. Methods 4 cases received arterial switch operation and senning operation from November 2004 to January 2008,including 1 case of TGA without VSD（TGA - IVS） , 3 TGA with VSD （TGA - VSD）, 2 TGA with Mild pulmonary valve stenosis. Results There no death during the operation or postoperation. Patients were followed up from 5 months to 3years. All the patients got better ,grew faster and cyanosis relieved apparently. 2 patients had mild to moderate mitral regurgitation preoperatively. 1 patient had mild mitral regurgitation post- operatively and 1 patient had no mitral regurgitation. There was no aortic stenosis or pulmonary valve stenosis after operation, lpatient assisted respiration for 62 days after operation because of old age. All the patients recovered smoothly after operation. Conclusion Using arterial switch operation and senning operation to correct complete transposition of great artery could get satisfying operative results,and the arterial switch operation will also get good effect in older children with better left ventricular development.