先天性纠正型大动脉错位不同手术方法结果的比较

Corrective surgery for congenitally corrected transposition of the great arteries in children

目的比较先天性纠正型大动脉错位（ccTGA）的各种手术治疗结果方法，为临床治疗ccTGA提出更合理的手术方式。方法1999年6月至2009年12月外科手术治疗95例ccTGA，包括传统纠治手术25例，功能性单心室纠治手术26例，双调转术（DoubleSwitch）手术26例，姑息手术15例，另有3例接受其他手术。结果术后死亡7例，其中传统手术组死亡2例，DoubleSwitch手术组死亡4例，其他手术组死亡1例，单心室手术组全部存活。结论纠正型大动脉错位的手术方法的选择取决于解剖条件和生理参数。在各类手术结果的比较中，功能性单心室纠治手术的死亡率低、并发症少、再手术率低，可适当放宽功能性单心室纠治手术指征，可能得到更好的治疗效果。但长期的手术疗效还有待于进一步随访。

Objective To study the clinical outcomes of various corrective surgeries for congenitally corrected transposition of the great arteries （ccTGA） in children. Methods Between June 1999 and December 2009, 95 patients with ccTGA who underwent corrective surgeries at this center were enrolled in this study. Among the 95 patients, 25 patients were performed conventional surgical repairs, 26 had functionally univentricular surgical repair, 26 had double switch operation, 15 had palliative surgeries, and 3 underwent other surgical treatments. Results Seven deaths after surgery were recorded, including 2 patients who had conventional surgical repairs, 4 with double switch operation and l with other surgical treatments. No death of the patients who underwent functionally univentricular surgical repair was noted. Conclusions The surgical strategy to correct ccTGA should be made according to patients＇ individual anatomic anomalies and pathophysiology. Short term outcome study revealed that functionally univentricular surgical repair is safe and effective.