完全性肺静脉异位引流外科治疗61例临床分析

Clinical Analysis of Total Anomalous Pulmonary Venous Connection Surgical Treatment in 61 Cases

目的总结完全性肺静脉异位引流(TAPVC)患者的外科手术治疗经验。方法 61例中,≤6月40例,>6月21例。患者经超声心动图确诊后,采用正中开胸,在中或深低温下进行外科手术矫治,其中在低流量体外循环下手术49例,停循环下手术12例。结果术后早期死亡8例,其中新生儿4例,死亡原因分别为低心排综合征4例、多脏器功能衰竭2例、严重室性心律失常1例、重症肺炎1例。晚期死亡3例,其中1例心上型患者于术后2月因肺部感染死亡,1例心内型患者于术后4月死于吻合口狭窄,另1例心内型患者于术后11月因肺静脉狭窄、心力衰竭死亡。结论 TAPVC患者一经心脏彩超检查确诊后应立即手术;术前肺静脉梗阻、左心室发育不良是导致患者术后死亡的重要原因,对此类患者,术中宜充分切开肺静脉共干至肺静脉分支开口处,切口与左房切口平行,确保吻合口足够大。

Objective To summary the experience of total anomalous pulmonary venous connection with surgical operation treatment.Methods In 61 cases,there are 40 cases ≤6 months and 21cases 6 months.Patients diagnosed by echocardiography,were operated following mid-sternalthoracotomy under normothermia or profound hypothermic CPB,including low flow rate in 49 cases and circulatory arrest in 12 cases.Results There were 8 cases of postoperative death,including 4 cases of neonatus,in which 4 cases of low heart row syndrome,2 cases of multiple organ failure death,1 case of serious ventricular arrhythmia and 1 case ofsevere pneumonia.3 cases of late death,1 case of supracardiac postoperative 2 months due to lung infection death,1 case of cardiac postoperative 4 months died in anastomosis stricture,another cardiac was postoperative 11 months died in pulmonary vein stenosis,cardiac failure.Conclusion The patients of TAPVC should be early operation,pulmonary venous obstruction,Restrictive asds,and left ventricular dysplasia is the important reason for the cause of death.For such patients,surgery should be fully open pulmonary vein stem to the pulmonary vein branches opening,incision parallel with the left atrial incision,large enough to ensure the anastomosis.