全腔静脉-肺动脉直接吻合术中期效果的临床研究

The midterm study of the direct superior and inferior cavopulmonary connections surgery

目的总结全腔静脉-肺动脉直接吻合(DCPC)Fontan术纠治功能性单心室的中期效果。方法 2005年1月至2011年5月我院共对25例复杂型心内畸形患儿施行DCPC Fontan术,男15例,女10例,平均年龄6.8岁(1.3～12.3岁);平均体重25.0kg(11.0～46.0kg)。病种为单心室7例,完全性大动脉错位(D-TGA)合并肺动脉狭窄伴室间隔缺损6例,纠正型大动脉转位(ccTGA)合并肺动脉狭窄伴室间隔缺损6例,完全性房室共通道的右心室双出口(DORV)4例,心脾综合征2例。术前分别行右侧双向腔肺动脉吻合术和双侧双向腔肺动脉吻合术各1例。结果其中10例患儿常规建立体外循环并阻断主动脉,体外转流时间76～179min,平均(134.7±43.8)min,主动脉阻断23～99min,平均(40.4±16.9)min;另15例患儿在平行循环下行DCPC术,体外转流时间82～139min,平均(112.1±26.3)min,不阻断主动脉。10例患儿合并其他心内畸形需纠治,15例患儿行"开窗术"。术后并发症为室上性心动过速1例,肾功能受损导致无尿需行腹膜透析1例,置胸腔引流管时间>7d5例,窦性心动过缓伴窦性停搏1例,心包积液1例。门诊随访2个月至6年,无一例死亡。结论 DCPC术中期随访效果满意,对术前具备肺动脉发育可,主、肺动脉位置合适及上、下腔静脉有足够长度等条件的患儿具有一定的适用性。

Objective To analyze the midterm results following the direct superior and inferior cavopulmonary connections(DCPC)Fontan in patients of functional single ventricule.Methods Between January 2005 and May 2011,25 consecutive patients were retrospectively reviewed.There were 15(60%)males and 10(40%)females with a media age of 6.8 years(range from 1.3 to 12.3 years)and a media weight of 25 kg(range from 11.0 to 46.0 kg).Results There was no death during hospital stay and follow-up.Aortic cross-clamping were used in 10 patients and the media cardiopulmonary bypass(CPB)time was(134.7±43.8)minutes(range from 76 to 179 minutes)and the media aortic crossclamping time was(40.4±16.9)minutes(range from 23 to 99 minutes).15 patients were performed without aortic cross-clamping.The media CPB time was(112.1±26.3)minutes(range from 82 to 139 minutes).Associated intracardiac procedures were performed in 10 patients.Fenestration were required in 15 patients.The follow-up period ranged from 2 months to 6 years.Operative mortality and late mortality after discharge was zero.Major postoperative complications included supraventricular tachycardia in 1 patient,oliguria and need of peritoneal dialysis in 1 patient,chest drainage over 7 d(>30 ml/d)in 5 patients(20%).1 patient developed sinus bradycardia in association with sinus pauses two months after discharge.1 patient developed pericardial effusion one month after discharge.Conclusions Direct superior and inferior cavopulmonary connections Fontan procedure in patients with functional single ventricle can be performed with low risk and a low reintervention rate.The midterm results were favorable.