一期Fontan手术治疗复杂紫绀型先天性心脏病21例

One-stage Fontan procedure in patients with complex cyanotic congenital heart disease: report of 21 cases

目的：总结一期房坦（ Fontan）手术治疗复杂紫绀型先天性心脏病的临床经验和疗效。方法2007-06～2012-12该院心血管外科对21例复杂紫绀型先天性心脏病患者施行了一期Fontan单心室手术，同期行房室瓣整形术8例。12例采取心内管道或自体心包内隧道连接，8例采取心外管道连接，1例采取不用管道材料肺动脉直接下拉吻合法。5例保留房间隔缺损或行心房板障开窗。结果20例手术获得成功，1例术后当天因低心排出量综合征死亡。1例房室瓣成形术后随访至25个月出现房室瓣重度反流，行机械瓣置换。术前经皮血氧饱和度为67％～91％，术后经皮血氧饱和度为88％～95％。术后随访（7～52个月）所有患者心功能Ⅰ～Ⅱ级。结论一期Fontan手术治疗复杂紫绀型先天性心脏病安全有效，可以避免多次手术创伤，节约医疗资源，但应注意把握手术适应证。

Objective To summarize the clinical experience and effect of One-stage Fontan procedure in pa-tients with complex cyanotic congenital heart disease .Methods From June 2007 to December 2012 ,21 patients with complex cyanotic congenital heart disease underwent One-stage Fontan procedure , 8 patients underwent atrioventricu-lar valve plastic operations at the same time .Surgical methods：intracardiac pipeline or tunnel were build in 12 pa-tients, extracardiac pipeline were build in 8 patients, end-to-end suturing between main pulmonary artery and inferior vena cava was performed in 1 patient.Atrial septal defect were retained or trepanning of interatrial septum were per -formed in 5 patients.Results The operations in 20 patients were successful ,and 1 patient died of low cardiac output syndrome on the right postoperative day .One patient underwent artificial mechanical heart valve replacement because of severe regurgitation after the atrioventricular valve plasty was performed 25 months later.The preoperative percuta-neous oxyhemoglobin saturation were between 67% and 91%,and postoperative percutaneous oxyhemoglobin satura-tion were between 88%and 95%.The cardiac function of all cases were in NYHA classⅠtoⅡ between 7 and 52 months of post-operation follow-up.Conclusion One-stage Fontan procedure in patients with complex cyanotic con-genital heart disease were safe and effective , without surgical wounds of reoperation ,and saving medical resource ,but the operation indication must be controlled .