NorwoodⅠ期手术单中心经验

Experience of one center on the Norwood stage Ⅰ procedure

目的总结开展NorwoodⅠ期手术的临床应用经验。方法2016年6月至2018年10月,5例新生儿行NorwoodⅠ期手术,男3例,女2例;体质量2.10~3.90kg,中位值2.95kg;手术时为出生后1~8天。5例均在深低温停循环下行Norwood手术,其中例1、2、3采用改良B-T分流,例4、5采用RV-PA分流。结果例3术后第2天成功关胸并脱离呼吸机,术后第6天因重度感染致弥漫性血管内凝血死亡。例5术后10h死于心包压塞。例1、2、4术后随访,出院1个月心功能Ⅰ级。例1、2因个人原因未再随访;例4术后9个月行双向Glenn手术,术后恢复顺利。结论经典Norwood手术的改良方法和技术的应用,有助于积累治疗左心发育不良类疾病的经验。

Objective To review the clinical experience with the Norwood stage Ⅰ procedure. Methods Between June 2016 to October 2018, totally 5 neonates underwent Norwood stage Ⅰ procedure. There were 3 boys and 2 girls, weighing(2.98 ± 0.60)kg with median of 2.95 kg.Age at surgeries ranged from 1 to 8 days. All 5 cases underwent the Norwood stage Ⅰ procedure under deep hypothermic circulatory arrest, including 3 cases of modified Blalock-Taussig shunts(MBTS) and 2 cases of RV-PA shunt. Results The third case was successfully closed the chest on postoperative day 2 and extubated, but died from DIC due to severe infection on the postoperative day 6. The fifth case died from pericardiol tamponade at 10 hours after the operation. The first, second and fourth cases were followed up 1 month after discharge with NYHA Ⅰ, but the first and second cases dropped out of follow-up due to some personal resaons. The fourth case underwent the bidirectional Glenn procedure 9 monthes after the stage Ⅰ procedure and recovered smoothly. Conclusion The application of these modified methods and techiques based on the classical Norwood procedure help to accumulate experience in sugical treatment of HLHS in China.