176例右心室双出口的手术治疗分析

Surgical treatment for double-outlet of right ventricle in 176 cases

目的观察并探讨右心室双出口(DORV)手术矫治的疗效和治疗方法。方法分析1998年1月至2010年1月间176例DORV病人手术治疗的疗效。其中男105例,女71例,124例室缺(VSD)位于主动脉口下,12例室缺位于肺动脉口下,32例室缺位于两大动脉开口下,8例室缺远离两大动脉开口。114例建立室缺到主动脉口心内隧道,或者同时行右室流出道加宽,21例行内隧道外管道手术(Rastelli),18例行改良G lenn分流术,11例行Fontan纠治术,7例行大动脉调转术(Sw itch)。结果住院期间死亡18例;出院后116例获随访,时间为6个月至8年,临床效果满意。结论 DORV解剖类型复杂多样,心室内隧道或补片要简洁,以确保左心室流出道顺畅。室缺位置及左室发育状况决定手术方案及疗效。

Objective To explore the treatment method for double-outlet of right ventricle（DORV）and to observe its clinical efficacy.Methods Totally 176 patients（105 male and 71 female） with DORV from January 1998 to January 2010 were enrolled including 124 patients of subaortic ventricular septal defect（VSD）,12 of subpulmonary VSD,32 of subarterial VSD and 8 of non-subarterial VSD.Surgeries to establish intraventricular tunnel or to enlarge right ventricular outflow tract with autologous pericardial patch were carried out in 114 cases,Rastelli procedure in 21 cases,bidirectional Glenn shunt in 18 cases,Fontan procedure in 11 cases and arterial switch operation in 7 cases were performed respectively.Results There were 18 patients died during the hospitalization.After discharge,116 patients were followed up for 6 months to 8 years with satisfactory results.Conclusion The anatomical pattern of DORV is complex,therefore intraventricular tunnel or autologous pericardial patch should be simple to ensure the smooth outflow of left ventricle.The position of ventricular septal defect and development condition of left ventricle are decisive to the operation style and outcome.