改良全腔静脉-肺动脉连接术治疗功能性单心室

Modified total cavopulmonary connection for treating patients with functional single ventricle

目的 为了进一步改善全腔静脉 肺动脉连接手术的效果 ,探讨其经典手术方式的改良方法。 方法 对 13例功能性单心室患者施行了改良全腔静脉 肺动脉连接手术 ,将上腔静脉远心端与右肺动脉上缘作端侧吻合 ,吻合口尽量偏左 ,近心端与右肺动脉下缘吻合 ,吻合口尽量偏右。其中 5例在心脏不停跳下用Gore Tex心外管道连接下腔静脉与右肺动脉下缘 ,8例采用心房内隧道。 结果 术后早期死亡 1例 (7 7% ) ,12例 (92 3% )存活者术后呼吸空气时血氧饱和度达 (94 6± 1 2 )% ,心脏造影检查示下腔静脉血主要流入右肺 ,上腔静脉血主要流入左肺。随访 6～ 2 6个月 ,无晚期死亡 ,其中心功能I级 10例 ,II级 2例。超声心动图检查示心室容积明显缩小 ,心室收缩功能正常。 结论 改良全腔静脉 肺动脉连接术 ,使两肺血流分布比较符合生理 ,而且能有效地提高患者术后血氧饱和度、减轻心室容量负荷及改善心室功能。

Objective[WT5”BZ] To modify the classic procedure for better surgical results of total cavopulmonary connection (TCPC). [WT5”HZ]Methods[WT5”BZ] Modified TCPC was performed in 13 patients with functional single ventricle. In the modified TCPC procedure, the distal end of the superior vena cava(SVC) was connected with the upper edge of the right pulmonary artery(RPA) with the anastomosis orifice near the left side, and the proximal end with the lower edge of RPA with the anastomosis orifice near the right side. Among them, intra atrial tunnel was established with a partial tube of PTFE using the lateral tunnel technique in 8 patients, and the distal end of the inferior vena cava(IVC) was directly connected with the lower edge of RPA using extracardiac conduit in the beating heart in 5. [WT5”HZ]Results[WT5”BZ] One patient (7 7%) died early. Twelve patients survived and had the SatO 2 (94 6±1 2)% postoperatively while inspiring air. Angiography showed that most blood from IVC enters the right lung and most blood from SVC the left lung. No late mortality was seen during the follow up for 6 months to 2 years and 2 months. NYHA class I was noted in 10 patients and class II in 2. Echocardiography showed that left ventricular volume reduced significantly and ventricular function was normal. [WT5”HZ]Conclusions[WT5”BZ] Modified TCPC produces optimal blood flow between the two lungs, elevates postoperative Sat O 2 effectively, decreases ventricular volume load and improves ventricular functions.