新生儿完全性肺静脉异位引流的手术治疗

Surgical approach to total anomalous pulmonary venous connection in 34 cases of neonate

目的总结新生儿期完全性肺静脉异位引流（TAPVC）的手术治疗经验及疗效。方法回顾2011年3月至2014年5月，在我科手术治疗的新生儿 TAPVC 34例的病历资料，男23例，女11例。手术年龄6～28 d，平均（15．00±4．60）d，体重2．6～4．5 kg，平均（3．70±0．96）kg。其中心上型21例（垂直静脉位于左侧19例，位于右侧2例），心下型3例，心内型9例，混合型1例。心上型和心下型 TAPVC 采取胸部正中切口入胸，将肺静脉共汇与左心房顶做侧侧吻合，结扎或切断缝扎垂直静脉。心内型及混合型 TAPVC 采取右腋下切口，充分剪除冠状静脉窦顶与左心房、房间隔组织，使肺静脉与左心房畅通沟通，同时将冠状静脉窦隔于左心房。体外循环时间39～143 min，平均（78．76±27．17）min；主动脉阻断时间21～73 min，平均（37．71±10．51）min。结果术中均常规安置心表临时起搏器，启用9例。术后早期死亡3例（8．82％），低心排出量综合征7例，心律失常4例，肺炎7例，31例随访1个月至3年，无死亡及因吻合口狭窄再次手术的患儿，超声心动图检查示吻合口血流速度均＜1．4 m／s。结论新生儿期 TAPVC 患儿行手术治疗临床效果满意。

Objective To summarize the experience of surgical treatment of total anomalous pulmonary venous connection （ TAPVC）.Methods From March 2011 to May 2014,34 neonates less than 28 days old underwent surgical correction of TAPVC,23 males and 11 females,aged from 6 days to 28 days with a mean of （15.00 ±4.60）days,body weight from 2.6 to 4.5 kg with a mean of（3.70 ±0.96）kg.There were 21 cases of supracardiac type（vertical vein was located on the right side in 2 cases and left side in 19 cases）,1 case of mixed type,9 cases of cardiac type and 3 cases of infracardiac type.Median sternotomy was used;the pulmonary veins confluence was anastomosed to the left atrium （ side-to-side anastomosis ） for the supracardiac and infracardiac TAPVC.In cardiac TAPVC repair procedure,the tissue between the foramen ovale and coronary sinus was incised and extended in the roof of the coronary sinus to the posterior wall of the heart ,so the blood from pulmonary vein flow through the left atrium without obstruction .Cardiopulmonary bypass time was 39-143 min, the average （78.76 ±27.17）min;aortic clamp time was 21-73 min,the average（37.71±10.51）min.Results Early mortality was 8.82%（3 /34）,low cardiac output syndrome occured in 7 cases,arrhythmia in 4 cases,pneumonia in 7 cases and temporary pacing were used in 9 cases.Thirty-one cases were followed up from one month to three years ,no death and re-operation for correction of anastomotic stenosis in children .Echocardiography suggested that blood flow velocity in the anastomotic orifice was less than 1.4 m/s.Conclusions Surgical operation should be undertaken early in neonate with TAPVC.