不同手术方法治疗心上型完全性肺静脉异位引流

Clinical analysis of different surgical treatments for supracardiac total anomalous pulmonary venous drainage

目的:比较心上型完全性肺静脉异位引流(TAPVC)的各种手术治疗效果,为临床治疗TAPVC提出更合理的手术方式。方法:2000年8月～2011年4月外科手术治疗60例心上型TAPVC,包括经房间隔手术14例,经左右心房手术19例,心上法27例。结果:术后死亡4例,其中经房间隔手术死亡2例,经左右心房死亡1例,心上法死亡1例。术后主要并发症为肺静脉梗阻、低心排、手术创伤所致心律失常、左心发育不良所致急性肺水肿、呼吸衰竭。其中心上法手术患者并发症明显低于其他两组。结论:心上径路治疗心上型TAPVC近、中期效果良好,远期效果有待进一步随访。

AIM： To compare the effect of different surgical approaches for supracardiac total anomalous pulmonary venous connection （TAPVC）. METHODS： Sixty patients with supracardiac TAPVC underwent surgical repair from August 2000 to April 2011, including 14 patients using the right atrium approach, 19 patients through right and left atrium incisions and 27 patients using the superior approach. RESULTS： Four patients （two with right atrium approach, one with right and left atrium incisions and one with superior approach ） died after surgical repair. The main complications were pulmonary vein obstruction, low cardiac output, arrhythmia, acute pulmonary edema due to hypoplastic left heart, or respiratory failure. The complications in the superior approach group were significantly lower than those in the other two groups. CONCLUSION： Superior approach shows good short- and medium-term effect in the treatment of supracardiac TAPVC, but the long-term effect needs further follow-up.