经左心房内吻合治疗心下型完全性肺静脉异位引流

Efficacy of left atrial anastomosis for repairing infracardiac total anomalous pulmonary venous connection

目的评估经左心房内径路吻合治疗心下型完全性肺静脉异位引流（total anomalous pulmonary venous connection，TAPVC）的疗效。方法2012年3月至2015年4月，采用左心房内路径吻合法治疗心下型TAPVC14例。男9例，女5例。年龄8～42d，平均（28．9±6．73）d；体重2．8～5．4kg，平均（3．9±1．43）kg。所有患儿均在全身麻醉、中低温体外循环下手术。充分游离左、右肺静脉、共汇静脉、垂直静脉后，在心脏自然状态下观察共汇静脉一垂直静脉与心脏位置关系，对共汇静脉一垂直静脉走形位于左房或房间隔后位的14例患儿，采用左心房内径路将肺静脉共汇一垂直静脉与左心房后壁吻合。结果所有患儿均顺利完成手术，体外循环时间89～141min，平均（118．7±22．14）min；主动脉阻断时间46-67min，平均（52．1±6．54）min。术后呼吸机辅助时间3～7d，平均（4．19±1．04）d。术后早期（46h）1例患儿因消化道出血死亡，其余13例患儿中，低心排出量综合征8例、室上性心动过速2例、气胸2例、肺部感染7例、经积极治疗后均痊愈出院。13例患儿出院后1个月、3个月、1年随访率均为100％。结论对共汇静脉一垂直静脉走行位于左房或房间隔后的心下型TAPVC，采用左心房内路径吻合法治疗能够取得满意的临床疗效。

Objective To evaluate the efficacy of left atrial anastomosis in repairing infracardiac total anomalous pulmonary venous connection （TAPVC）. Methods From March 2012 to April 2015, 14 surgical cases of infracardiac TAPVC were reviewed. There were 9 boys and 5 girls with a mean age of （28. 9 ± 6. 73） （8-42） days and a mean body weight of （3.9 ± 1.43） （2. 8-5. 4） kg. Low- temperature extracorporeal circulation was performed under general anesthesia, pulmonary vein confluence-vertical vein and left and right pulmonary veins were adequately dissociated and their position relations with heart observed under a natural state. In 14 cases, pulmonary vein confluence- vertical vein was located behind left atria or interatrial septum. Pulmonary vein confluence-vertical vein was anatomosed side-to-side to left atrium through left atrium. Results All procedures were successfully completed. The mean CPB time was （118. 7 ± 22. 14） （89-141） min, mean postoperative respiratory machine auxiliary time （4. 19 ± 1.04） （3-7） days and mean aortic clamping time （52. 1 ± 6. 54）（46-67） min. Early mortality was 7. 14%. The postoperative complications included low cardiac output syndrome （n = 8）, supraventricular tachycardia （n = 2）, pneumothorax （n = 2） and pneumonia （n = 7）. All recovered after active interventions. Conclusions Left atrial anastomosis is both safe and effective for children with infracardiac TAPVC.