138例右心室双出口的外科治疗

Surgical treatment for double outlet of right ventricle in 138 cases

目的总结手术矫治右心室双出口(DORV)的疗效及安全性。方法回顾性分析1992年1月至2009年6月138例DORV患者手术治疗的效果及安全性。结果 90例建立室间隔缺损到主动脉口心内隧道,或者同时行右室流出道加宽,18例行内隧道外管道手术(Rastelli),16例行改良Glenn分流术,8例行Fontan纠治术,6例行大动脉掉转术(ASO)。术后早期死亡18例,出院后随访96例,随访3个月至8年,临床效果满意。结论 DORV解剖类型复杂多样,术前应尽量明确诊断,选择合适的手术方案;术中应仔细探察,需根据每例患者的具体情况,及时调整手术方式,是DORV患者手术治疗成功的关键。

Objective To summarize the experience and results of surgical treatment for double outlet of the right ventricle（DORV）.Methods From January 1992 to June 2009,138 patients with DORV（age ranging from 2 months to 23 years） underwent surgical treatment.There were 85 males and 53 females.There were 106 subaortic ventricular septal defect（VSD）,22 command doubly committed VSD,6 subpulmonary VSD,4 noncommitted VSD.90 cases underwent intraventricular tunnel and relive right ventricle outflow tract directly with pericardial patch or homograft valves conduits,and Rastelli procedure in 18;Bidirection cavopulmnary connection in 16,total cavopulmonary connection（TCPC） in 8,arterial switch operation in 6.All patients underwent the procedure by cardiopulmonary bypass.Resluts There were 18 cases of early death.96 cases were followed up from 3 months to 8 years.All cases were asymptomatic and did well in ordinary life.The cardiac function was in NYHA class Ⅰ in 62 and class Ⅱ in 34.The outcome was satisfactory.Conclusion There is significant correlation between anatomy and surgical strategies.Position of ventricular septal defect and development of left ventricle significantly influence the surgical outcomes.