大动脉调转术纠治完全性大动脉转位的外科治疗体会

Surgical treatment and analysis of arterial switch operation with complete transposition of the great arteries

目的研究和探讨完全性大动脉转位行大动脉调转术外科手术治疗和临床结果分析。方法自2003年8月至2015年12月,我院共完成完全性大动脉错位行大动脉调转术(Switch术)31例,一期Switch术29例,二期Switch术2例,室间隔完整型大血管错位(D-TGA/IVS)18例,合并室间隔缺损(D-TGA/VSD)13例,男21例,女10例,年龄5h-6M(25±10.3d),体重2.4-6(3.50±1.22)kg。结果全组31例,手术死亡2例均为冠脉畸形,术后早期监护室死亡2例,其余均康复出院,随诊1个月-5年远期无死亡,心脏超声复查恢复良好,肺动脉轻度残余梗阻1例。结论完全性大动脉转位可以通过一期或两期大动脉调转术进行外科手术纠治,在新生儿期及早发现,早期手术,熟练手术精细操作,冠脉动脉移植保证心肌血运,是手术成功的关键。

Objective To Analysis and discuss transposition of the great arteries arterial switch operation for surgical treatment and clinical results. Methods From August 2003 to December 2015,our hospital completed a total of complete transposition of the great arteries switch operation in 31 cases,one stage switch operation in 29 cases,two stage switch operation in 2 cases,18 cases with intact ventricular septum vascular dislocation D-TGA/IVS,with ventricular septal defect in 13 cases,male 21 cases,10 cases of female,age 5h-6M（25＋10.3d）,body weight 2.4-6（3.50＋1.22）kg. Results All of the 31 cases,2 cases with coronary artery malformation died in operation,2 cases of early postoperative death in ICU,Follow up for 1 months-5 years of long-term no death,echocardiogram review good recovery,pulmonary artery mild residual obstruction in 1 case. Conclusion Completely of the great arteries transposition can through one or two stage arterial switch operation for surgical correction,in the neonatal period of early detection,early surgery,skilled fine surgical operation,coronary artery bypass grafting guarantee myocardial blood supply and is key to the success of the operation.