心下型完全肺静脉异位引流的心内法与上翻法的手术比较

Comparison of intracardiac and upturned approach for total anomalous pulmonary venous connection

目的分析不同手术方式治疗心下型完全肺静脉异位引流的手术效果,探讨心下型完全肺静脉异位引流的最佳手术入路。方法2011年7月至2019年8月,20例心下型完全肺静脉异位引流患儿完成矫治术,按随机数字表法分为两组,采用不同手术方式:A组心脏上翻法,12例;B组心内法,8例。比较两组体外循环、主动脉阻断、ICU滞留、机械通气、术后天数以及术后吻合口流速等数据。结果两组体外循环、主动脉阻断、ICU滞留和机械通气差异均无统计学意义。A组术后住院天数明显低于B组[(14.7±2.9)天对(16.1±6.2)天,P<0.05],A组术后吻合口流速>120 cm/s者显著多于B组(7例对1例,P<0.05)。A组住院死亡2例,B组无住院死亡。18例生存患儿顺利出院,均定期随访,随访10~96个月。B组1例术后2个月死于误吸,余无死亡。随访超声心动图示均无吻合口流速增快。结论心脏上翻法和心内法治疗心下型完全肺静脉异位引流的手术入路无显著差异,但心内法原位吻合,术后肺静脉梗阻概率低,可以优先选择。

Objective Analyze the effect of intracardiac method and upturning method in the treatment of infracardiac total anomalous pulmonary venous connection(TAPVC),to explore the surgical method of infracardiac TAPVC.Methods From July 2011 to August 2019,20 patients with infracardiac TAPVC were treated,including 12 cases with upturning method and 8 cases with intracardiac method.The cardiopulmonary bypass time,aortic cross-clamp time,delayed thoracic closure,ICU time,mechanical ventilation time,postoperative days and anastomotic flow rate were compared between the two groups.Results There was no significant difference in cardiopulmonary bypass time,aortic cross-clamp time,delayed thoracic closure,ICU time and mechanical ventilation time between the two groups.The postoperative hospital stay in upturning group was significantly lower than that in intracardiac group[(14.7±2.9)days vs.(16.1±6.2)days,P<0.05],and the postoperative anastomotic velocity>120 cm/s in intracardiac group was significantly less than that in upturning group(1 case vs.7 cases,P<0.05).Two patients died in upturning group,but there was no significant difference compared with the intracardiac group.Conclusion There is no significant difference between the two methods in the treatment of subcardiac TAPVC.The authors think that the exposure of the upturning methods is difficult,and the distortion of the anastomosis may be hidden trouble.The in situ anastomosis of the intracardiac method is not easy to make mistakes.