婴幼儿完全性肺静脉异位引流的外科治疗

Surgical Treatment of Total Anomalous Pulmonary Venous Connection in Infants

目的：对婴幼儿完全性肺静脉异位引流的外科治疗进行分析总结。方法：选取山西省儿童医院心胸外科2009年10月-2014年4月收治的TAPVC患儿21例,其中心上型12例、心内型7例、混合型1例、心下型1例,均在体外循环下行完全性肺静脉异位引流矫治术。结果：主动脉阻断时间为（42.6±21.3）min,体外循环时间为（84.6±28.4）min,术后呼吸机使用时间（3.42±2.01）d。所有患儿手术均成功,早期无死亡。围手术期出现低心排2例,肺高压危象1例,合并肾功能不全1例,出现房性早搏3例,节性心律2例,延迟关胸1例,均经治疗后出院。术后随访3个月-2年,除1例心上型TAPVC患儿,术后1年出现吻合口狭窄,肺静脉梗阻,死于严重心衰。余患儿生长发育良好,紫绀消失。多次复查心脏彩超,吻合口无梗阻,房室腔较前减小或基本接近正常。结论：对TAPVC患儿,一旦确诊,就应该尽早手术治疗,术中吻合口足够大是手术成功的关键。同时加强术后监护治疗,防止术后低心排及肺动脉高压危象的发生,并加强术后随访。

Objective： To summarize the experience of the surgical treatment for infants and children with total anomalous pulmonary venous connection （TAPVC） . Methods： 21 patients with TAPVC were conducted surgical therapy, including 13 boys and 8girls with main age at 4.3 ± 1.2month from 54 days to 12 months,with weight at 5.42 ± 1. 41Kg from3.6kg to 9.3 kg ,in which 12 cases were in supraeardiac type,7 cases in cardic type, 1 case in mixed type and 1 case in intracardiac type . The correction of TAPVC was performed under moderate hypothermic cardiopulmonary bypass with all patients. Results： The aortic clamping time was （42.6 ± 21.3）min, eardiopulmonary bypass time （84.6±28.4） rain, and postoperative respirator use time （3.42 ± 2.01）. All children were performed successfully without early death. In the early postoperation, 8 cases occurred with pneumonia, 2 cases of low cardiac output syndrome, lcases with pulmonary hypertension crisis, 1 case of renal insufficiency,in 3 cases of premature beat, section sex rhythm of the heart in 2 cases, and delay closed chest in 1 case. All recovered after treatment. Follow -up was completed in 21 patients from 3 months to 2 years. The children were in good condition. The eyanosis disappeared. With multiple reexamination, the eehocardiographie was no obstruction; anastomotic atrioventricular cavity was reduced or basic close to normal earlier. Conclusions： The infants and children who are once diagnosed TAPVC should be taken early surgical treatment with the postoperative care, and enough intraoperative anastomotie stoma is the key to successful operation. Meanwhile, it is important to prevent the occurrence of postoperative low cardiac and pulmonary hypertension crisis and strengthen postoperative follow-up.