非体外循环下右心旁路手术治疗复杂先天性心脏病

The result of right heart bypass operation for the treatment of complex congenital heart diseases

目的总结非体外循环下右心旁路手术治疗复杂先天性心脏病的临床经验。方法采用非体外循环右心旁路手术治疗94例复杂先天性心脏病(包括三尖瓣闭锁、单心室等,其中心脏位置异常27例),68例行双向格林术,26例行全腔静脉-肺动脉吻合术,其中3例术中改为体外循环。结果双向格林术围手术期手术死亡2例,全腔静脉-肺动脉连接术后死亡2例,围手术期死亡率(4.3%)。结论右心旁路手术治疗复杂先天性心脏病分期手术效果好,但手术难度增加。全腔静脉-肺动脉吻合术,外管道与右心房开窗效果好。

Objective To evaluate the results of right heart bypass （RHB） with 0ff-pump technique operation for treating complex congenital heart disease. Mothods From October 2005 to November 2010, 94 patients with complex congenital heart disease, including tricuspid atresia, single ventricle and 27 cases of ectopia cordis were included. Six-ty-eight cases, underwent bidirectional Glenn shunt and 26 cases underwent total cavopulmonary connection （TCPC）. Result Four patients died, and the hospital mortality rate was 4.3%, and one patient had chylothorax. Conclusion RHB is a effective way to treatcomplex congenital heart disease, but the procedure itself is difficult. 1. Step-wise operation is better. The effect of extracardiac conduit operation with windowing operation is better than TCPC. RHB with off-pump technique is a useful procedure in early stage management.