心外管道全腔静脉肺动脉连接术

Total extracardiac cavopulmonary connection

目的 报告心外管道全腔静脉肺动脉连接术 (TECPC)应用经验。方法 横断上腔静脉与右肺动脉端侧吻合 ,切断下腔静脉前壁 ,保留原位吻合口 ,将下腔静脉通过人工血管与主肺动脉吻合 ,共治疗 9例复杂性先天性心脏病 ,其中 1例单心室改良Fontan术后 4年频发室上性心动过速而改行TECPC。结果 全组手术后均生存。 3例术后出现胸腔积液、乳糜胸并发症 ,均治愈。血流动力学指标满意 ,术后随访心功能I～II级 ,无心律紊乱发生。结论 TECPC手术操作简单 ,并发症少 ,适应证广泛 ,优于改良Fontan手术和传统的全腔静脉肺动脉连接术。

Objective: To report the surgical experience of the total extracardiac cavopulmonary connection (TECPC) for complex congenital heart diseases. Methods: Nine patients with complex congenital heart disease underwent TECPC. Of them, one patient with univentricular heart had modified Fontan operation 4 years ago, has suffered from superaventricular tachyarrthymia. The surgical procedures included a bidirectional cavopulmonary anastomosis with a Gore Tex extracardiac conduit interposition between the inferior vena cava and the main pulmonary artery without transecting the inferior vena cava, and reserving the stoma in situ. 6 patients were operated on without cramping the circulation. Results: There was no operative death. The hemodynamic data were satisfactory. 3 patients had pleural effusions and chylothorax postoperatively. Conclusion: TECPC is superior to the modified Fontan operation and traditional total cavopulmonary connection for complex congenital heart diseases.