肺动脉狭窄合并肺静脉异位引流先天性心脏病的双向格林手术临床分析

Bidirectional Glenn procedure treating pulmonary artery stenosis complicated with anomalous pulmonary venous drainage

目的总结肺动脉狭窄合并肺静脉异位引流先天性心脏病行上腔静脉一肺动脉双向分流术（双向格林手术）的经验和体会。方法选取2012年1月至2017年6月于首都医科大学附属北京安贞医院行双向格林手术的肺动脉狭窄合并肺静脉异位引流的复杂先天性心脏病患儿14例。其中5例在体外循环下完成，同时矫治完全性肺静脉异位引流，非体外循环下完成9例。结果本组患儿死亡1例，手术病死率7．1％（1／14）。术后并发症4例（28．6％），均为右侧胸腔积液，其中乳糜胸l例，经内科保守治疗后痊愈。术后血氧饱和度由术前（72±10）％提高至（91±4）％。结论虽然肺动脉狭窄合并肺静脉异位引流的先天性心脏病是双向格林手术的高危因素，但采用恰当的手术方式也能取得满意的效果。

Objective To review the experience of superior vena cava-pulmonary artery shunt （bidirectional Glenn shunt ） treating pulmonary artery stenosis complicated with anomalous puhnonary venous drainage. Methods Fourteen children with puhnonary artery stenosis complicated with anomalous pulmonary venous drainage undergoing bidirectional Glenn shunt from January 2012 to June 2017 in Beijing Anzhen Hospital, Capital Medical University were enrolled. Five children had extracorporeal circulation and simultaneous correction of total anomalous pulmonary venous drainage; 9 children had operation without extracorporeal circulation. Results There was 1 death and the operative mortality was 7.1% （1/14）. There were 4 cases（28.6% ） of postoperative complications： right pleural effusion occurred in 4 cases, including 1 case of chylothorax which recovered after conservative treatment. Postoperative oxygen saturation increased from （72 ± 10） % to （91 ± 4） %. Conclusion Although pulmonary stenosis complicated with anomalous pulmonary venous drainage is a high risk factor of bidirectional Glenn shunt, optimistic results can be achieved by appropriate surgical procedures.