完全性肺静脉异位引流的诊断与外科治疗策略

Surgical treatment strategies and diagnosis of total anomalous pulmonary venous drainage

目的探讨完全性肺静脉异位引流（TAPVD）的诊断和外科手术治疗策略。方法回顾性分析我院自2006年5月~2011年5月收治的12例接受外科手术的完全性肺静脉异位引流患儿的病历资料。全组12例患儿术前均行经胸心脏超声（TTE）和64层螺旋CT（MSCTA）检查。结果手术证实共有49支异位肺静脉干,心脏超声检出42支,而MSCTA全部检出。MSCTA、TTE异位肺静脉干检出率分别为100%、85.7%,差异有统计学意义（χ2=5.14,P〈0.05）。全组手术顺利,围术期无死亡,所有患儿均治愈出院。结论采用64层螺旋CT检查对确诊TAPVD切实可靠;外科手术治疗TAPVD安全有效,减少术中手术创伤、保证吻合口通畅,是提高治愈率、降低并发症发生率的关键。

Objective To explore the value of 64-slice helical CT angiography （MSCTA） in diagnosis and the surgical treatment strategies of total anomalous pulmonary venous drainage （TAPVD） in patients with congenital heart disease （CHD）. Methods The information of 12 patients with TAPVD diagnosed definitely by department of cardiac surgery in the hospital from May 2006 to May 2011 was analyzed retrospectively. All patients had been received transthoracic echocardiography（TFE） and contrast-enhanced 64-slice helical CT angiography （MSCTA） and three-dimensional（3D） reconstructions before operation. Results The 49 pulmonary veins of anomalous drainage diagnosed by surgery, TI＇E found 42 branch, 7 branch were missed, the diagnostic accordance rate was 85.7%; but MSCT found them all, the diag- nostic accordance rate was 100%. There was significant difference between two methods （X2=5.14,P〈0.05）. There was no operative death, all discharged from hospital after treatment. Conclusion MSCT is a good noninvasive and ac- curate and important diagnostic method in preoperative evaluation and selecting operative modalities for TAPVD. The key to successful operation lies on enough anastomotic orifice and avoidance of anastomotic stenosis.