10例单向与双向Glenn手术的评价

Bi-directional and Mono-directional Glenn Operation: A Report of 10 Cases

报道 10例单向与双向 Glenn手术。其中 7例单向 Glenn手术 ,上腔静脉与右肺动脉进行侧侧吻合 ,结扎右肺动脉近心端 ,环缩上腔静脉近心端。 3例双向 Glenn手术 ,上腔静脉与右肺动脉进行端侧吻合 ,上腔静脉近心端予以缝闭。手术结果 ,单向 Glenn手术患者 ,术后动脉血氧饱和度由术前的 5 0 %～ 6 0 %提高至术后的 70 %～ 80 %。双向 Glenn手术患者 ,术后动脉血氧饱和度由术前的 5 0 %～ 6 0 %提高至 85 %～ 90 % ,术后缺氧状态基本消失。手术结果表明 :双向 Glenn手术 ,上腔静脉的血流均匀地灌注左、右两侧肺 ,来自右心室的搏动性血流 ,促进了肺循环的血流灌注 ,因而双向 Glenn手术的患者 ,术后缺氧状态的改善远比单向

Bi directional and mono directional Glenn operations in 10 cases were reported. The mono directional Glenn operation ( n =7) was performed by side to side anastomosis of superior vena cavae (SVC) with right pulmonary artery (RPA) with a beating heart supported by cardiopulmonary bypass. In addition, the proximal right pulmonary artery was completely occluded by ligation and the proximal superior vena cavae was banded. In bi directional Glenn operation ( n =3), a end to end anastomosis was constructed at SVC and RPA with the closure of the proximal SVC. It was showed that in mono directional Glenn operation, the arterial SaO 2 was increased from 50 %～60 % preoperatively to 70 %～80 % postoperatively, and the cyanosis was moderately reduced. Meanwhile, in bi directional Glenn operation, the arterial SaO 2 was increased to 85 %～90 % relatively; and the clinical ischemia symptom was improved significantly. The results indicated that in bi directional Glenn operation, the blood from SVC could irrigate bilateral pulmonary vessel bed and the pulsated blood flow from right ventricular would improve pulmonary circulation. Hence the improvement of postoperative ischemia state in the patients receiving bi directional Glenn operation was more satisfactory than those receiving mono directional Glenn operation.