完全性房室间隔缺损手术治疗76例临床分析

Clinical analysis for the surgical treatment of 76 cases with complete atrioventricular septal defect

目的 总结76例完全性房室隔缺损的手术治疗情况,为今后掌握最佳手术时机及手术方法提供参考.方法 根据Rastelli分型：A型57例,B型6例,C型13例.采用“二片”修补法畸形矫治65例,室间隔缺损直接缝合法7例,格林（Glenn）分流术4例.结果 手术死亡2例,1例为合并右室双出口及完全性肺静脉异位引流,术后死于低心排综合征,另1例为并发严重肺动脉高压,术后出现低氧血症,呼吸衰竭而死亡.余患者随访1 ～10年,3例患者发现二尖瓣中度返流,9例二尖瓣轻度返流.结论 对于已确诊的完全性房室隔缺损患者,应尽早手术治疗,以防疾病的进一步恶化,同时纠正合并畸形.

Objective To achieve the best chance and optimize the method of operation,the clinical outcomes of 76 cases with complete atrioventricular septal defect （CAVSD） were summarized.Methods According to the Rastelli classification,there were 57 cases of type A,6 type B,and 13 type C.The repaired procedures included the two-patch technique for atrioventricular septal defect （65 cases）,direct closure of ventricular septal defect （7 cases）,and the Glenn bidirection shunt （4 cases）.Results Two patients died.Of them,one was concomitant with double outlet right ventricle （DORV） and total anomalous pulmonary venous connection （TAPVC）,died of low cardiac output syndrome; another was complicated with severe pulmonary hypertension,and the death reason was hypoxaemia and respiratory function failure.The survived patients were followed up,and the follow-up period was varied from one to ten years,mitral valve regurgitation was found in 12 cases,3 were middle and 9 were mild.Conclusions In order to prevent deteriorated condition of these patients and improve the survival rate,CAVSD should be operated as soon as the diagnosis is certain,and the co-exist malformation also should be corrected.