成人功能性单心室的一期Fontan手术治疗

One-stage Fontan procedure in adults with functional single ventricle

目的:总结和分析成人功能性单心室Fontan手术治疗的早、中期结果。方法:自2001年11月～2010年11月,共15例成人功能性单心室患者行一期Fontan手术治疗,术前心功能NYHAⅡ级4例,NYHAⅢ级11例;手术适应证为肺动脉发育良好,肺动脉平均压≤15 mmHg;手术方法为心外管道法Fontan手术,6例行人工血管和右心房开窗吻合,随访3月～6年。结果:围术期死亡2例,术后平均拔除气管插管时间11 h(6～576 h),平均住院时间13 d(7～44 d),平均中心静脉压13 mmHg(7～16 mmHg),平均动脉血氧饱和度96%(87%～99%);12例患者心功能得到明显改善,4例心功能NYHAⅠ级,8例心功能NYHAⅡ级,1例心功能仍为NYHAⅢ级。结论:一期心外管道法Fontan手术治疗成人功能性单心室手术早期和中期疗效良好。

AIM： To report our experience of modified Fontan procedure for adults with functional single ventricle.METHODS： Data of 15 consecutive patients with single ventricle who were treated with one-stage extracardiac Fontan procedure between November 2001 and November 2010 were retrospectively analyzed.Preoperatively,four patients were in NYHA class II and 11 were in class III.The main factors for the selection of patients before surgery were well-developed pulmonary arteries with lower lobe index （120±30） mm/m2 and mean pulmonary artery pressure ≤15 mmHg.A fenestration 5 mm in size was constructed in six patients.RESULTS： Two cases of perioperative death occurred（total mortality 15%）.The mean extubation time and hospital stay were 11 h and 13 days,respectively.The mean central venous pressure（CVP） was 13 mmHg and the mean arterial oxygen saturation was 96%.During the 41-month follow-up（range： 3-72 months）,no patient died or developed arrhythmias.NYHA class improved significantly in the 12 survivors.CONCLUSION： The extracardiac Fontan procedure achieves good early-and mid-term outcome in adults with functional single ventricle,resulting in either complete or marked relief of cyanosis and enhanced exercise tolerance in all survivors.The results of long-term follow-up have yet to be established.