姑息性手术在复杂先天性心脏病患者中的应用

Palliative Surgery for Patients with Complex Congenital Heart Diseases

目的探讨姑息性手术在复杂先天性心脏病中的应用策略,提高其治疗效果及生存率。方法回顾性研究华中科技大学同济医学院附属协和医院2004年1月至2011年5月95例复杂先天性心脏病患者接受姑息性手术的临床资料,男62例,女33例;年龄1个月～37岁。施行改良Blalock-Taussig shunt(B-T分流术)12例,改良Brock’s手术23例,双向Glenn手术55例和肺动脉环缩术(Banding手术)5例;对术式的选择、手术效果影响因素等方面进行分析。结果本组共死亡10例,总病死率为10.5%(10/95),其余患者顺利出院。主要并发症为低心排血量综合征、低氧血症和肺部感染等。随访5个月～6年,心功能(NYHA)Ⅰ～Ⅱ级。9例行改良Brock’s手术后患者已完成根治术,6例双向Glenn手术后患者完成全腔静脉-肺动脉吻合术。讨论由于相当部分患者错过了最佳手术干预时机,而影响手术效果;在姑息手术方式的选择策略上,需根据患者肺动脉发育状况、心内畸形特点、最终治疗目标等共同决定。

Objective To study palliative surgical strategies for patients with complex congenital heart diseases,and improve their clinical outcomes and survival rate.Methods We retrospectively analyzed clinical data of 95 patients with complex congenital heart diseases who underwent palliative surgical repair in Union Hospital of Tongji Medical College, Huazhong University of Science and Technology from January 2004 to May 2011.There were 68 male patients and 27 female patients with their age ranging from 1 month to 37 years.Modified Blalock-Taussig shunt（B-T shunt） was performed in 12 patients,modified Brock＇s procedure in 23 patients,bidirectional Glenn procedure in 55 patients and pulmonary artery banding in 5 patients.Surgical strategies and influential factors of treatment outcomes were analyzed.Results There were 10 in-hospital death with the overall mortality of 10.5%（10/95）.All the surviving patients were discharged successfully.Main postoperative complications included low cardiac output syndrome,hypoxemia and pneumonia.All the surviving patients were followed up for 5 months to 6 years,and in New York Heart Association（NYHA） functional class ⅠorⅡduring follow-up.During follow-up,nine patients after modified Brock＇s procedure received radical repair,and 6 patients after bidirectional Glenn procedure received total cavopulmonary connection.Conclusion A considerable number of patients with complex congenital heart diseases may miss their best timing for surgical repair,which significantly influences their surgical outcomes.We need to choose best palliative surgical strategy for these patients according to their pulmonary artery development condition,heart malformation characteristics and final treatment goal.